Increasing Dialysis Access Options in Lower Extremity: Retroperitoneal Approach for External Iliac Artery-Vein Arteriovenous Graft

Colvard, Benjamin; Anaya‐Ayala, Javier E.; Palacios-Reyes, Deborah; Cheema, Zulfiqar F.; Smolock, Christopher J.; Peden, Eric K.

doi:10.5301/jva.2011.6452

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…Previous reports from our institution have also described such aggressive, last-resort surgical techniques to establish dialysis access sites in the face of limited peripheral options, [9][10][11] but this report expands and further illustrates the utility of retroperitoneal approaches in access creation. Not only were the two target vessels on contralateral sides of this patient's body, but the graft itself connects two retroperitoneal vessels by passing through the anterior abdominal wall (Fig 2).…”

Section: Discussionmentioning

confidence: 66%

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access

Zamani

Anaya‐Ayala

Ismail

et al. 2012

Journal of Vascular Surgery

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We describe a novel arteriovenous graft configuration in the abdominal wall for hemodialysis in a 51-year-old woman with sickle cell disease. Upper extremity access sites were exhausted, and intrathoracic central veins occluded. Because of diminished quality of the left groin due to scar tissue from previous infected access, inadequate vasculature, and the presence of functional femoral catheter in the right groin with common iliac vein stenosis, we decided to create an arteriovenous graft from the left common iliac artery to the inferior vena cava. Adequate thrill and uneventful postoperative recovery was observed. At 4 months, the patient has been successfully using her graft.

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Section: Discussionmentioning

confidence: 66%

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access

Zamani

Anaya‐Ayala

Ismail

et al. 2012

Journal of Vascular Surgery

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“…However, these patients had completely exhausted venous options, and thus the risks of an artery-to-artery graft were worthwhile [17]. A variety of lower limb procedures have been described and use of the saphenous vein as a conduit has rather lost favour due to the high rates of failure and need for further intervention [18–22]. …”

Section: Discussionmentioning

confidence: 99%

Midterm Experience of Ipsilateral Axillary-Axillary Arteriovenous Loop Graft as Tertiary Access for Haemodialysis

Hunter

Nicholson

2014

Journal of Transplantation

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Objectives. To present a series of ipsilateral axillary artery to axillary vein loop arm grafts as an alternative vascular access procedure for haemodialysis in patients with difficult access. Design. Retrospective case series. Methods. Patients who underwent an axillary loop arteriovenous graft from September 2009 to September 2012 were included. Preoperative venous imaging to exclude central venous stenosis and to image arm/axillary veins was performed. A cuffed PTFE graft was anastomosed to the distal axillary artery and axillary vein and looped on the arm. Results. 25 procedures were performed on 22 patients. Median age was 51 years, with 9 males and 13 females. Median number of previous access procedures was 3 (range 0–7). Median followup was 16.4 months (range 1–35). At 3 months and 1 year, the primary and secondary patency rates were 70% and 72% and 36% and 37%, respectively. There were 11 radiological interventions in 6 grafts including 5 angioplasties and 6 thrombectomies. There were 19 surgical procedures in 10 grafts, including thrombectomy, revision, repair for bleeding, and excision. Conclusions. Our series demonstrates that the axillary loop arm graft yields acceptable early patency rates in a complex group of patients but to maintain graft patency required high rates of surgical and radiological intervention, in particular graft thrombectomy.

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“…The retroperitoneal approach for lower extremity AVG is a novel way to create vascular access for maintenance dialysis. Recently, Colvard et al [7] showed this technique in two cases in their center. This new approach may provide chances for some patients to continue dialysis.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Approach for Lower Extremity Arteriovenous Graft as Long-Term Vascular Access in a Complex Case

Zhu¹,

Shi

Cheng

et al. 2012

Case Rep Nephrol Urol

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A 76-year-old woman with stage 5 chronic kidney disease requiring hemodialysis had a long history of hypertension and diabetes. Her venous access was exhausted because of several previous access procedures including autogenous arteriovenous fistula operations and central venous catheter placements. After evaluating the function of her vessels when she was transferred to Renji hospital, we created an arteriovenous graft via a retroperitoneal approach in her right lower extremity. We inserted two grafts into her right thigh, a straight external ring and a loop graft. Twenty days after operation the patient’s new access was successfully used in the treatment of hemodialysis. She has been followed up to now without occurrence of any graft-related events.

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Increasing Dialysis Access Options in Lower Extremity: Retroperitoneal Approach for External Iliac Artery-Vein Arteriovenous Graft

Abstract: As the number of patients requiring lower extremity vascular access increases, new surgical techniques will become available to handle the clinical and anatomic challenges encountered in this population.

Cited by 5 publications

References 6 publications

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access

Midterm Experience of Ipsilateral Axillary-Axillary Arteriovenous Loop Graft as Tertiary Access for Haemodialysis

Retroperitoneal Approach for Lower Extremity Arteriovenous Graft as Long-Term Vascular Access in a Complex Case

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