Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

2021 ◽  
pp. 112972982110150
Author(s):  
Jeremy Liu ◽  
Josiah Situmeang ◽  
Devin Takahashi ◽  
Russell Harada
Keyword(s):  
Primary Patency ◽  
The Body ◽  
Secondary Patency ◽  
Close Monitoring ◽  
Arteriovenous Graft ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Brachial Vein ◽  
Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis

2020 ◽  
pp. 153857442096925
Author(s):  
Chen-Ting Cheng ◽  
Yuan-Chen Chang ◽  
Ka-Wai Tam ◽  
Yu-Chun Yen ◽  
Yu-Chen Ko
Keyword(s):  
Retrospective Study ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Basilic Vein ◽  
Arteriovenous Access ◽  
Secondary Outcomes

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.

Forearm versus upper arm grafts for vascular access

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S77-S81
Author(s):  
Shawn M. Gage ◽  
Jeffrey H. Lawson
Keyword(s):  
Clinical Success ◽  
Ulnar Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Potential Complication ◽  
Upper Arm ◽  
Operative Planning ◽  
Arteriovenous Grafts ◽  
Steal Syndrome

Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.

scholarly journals Long-term outcomes of thigh arteriovenous graft stenting

2021 ◽  
Vol 9 (3) ◽  
pp. 71-77
Author(s):  
Masa Abaza BS ◽  
Sloan E Almehmi ◽  
Alian AlBalas ◽  
Ammar Almehmi
Keyword(s):  
Patency Rate ◽  
Primary Patency ◽  
Secondary Patency ◽  
Venous Anastomosis ◽  
Stent Deployment ◽  
Kaplan Meier ◽  
Secondary Patency Rate ◽  
Study Population ◽  
One Year

Background: Stents have been increasingly used for treating venous anastomosis stenosis seen in arteriovenous grafts (AVGs). A major reason for this trend is that stents can potentially confer a better patency rate compared to angioplasty. However, limited data are available about the outcomes of stents that are used to treat thigh AVG dysfunction. This study sought to assess the primary and secondary patency rates of stents used to treat thigh AVGs dysfunction at one year. Methods: This is a retrospective study of dialysis patients who received therapy via thigh grafts (N=50) and underwent stent placement between January 2005 and June 2017 at our center. Data on demographics and baseline characteristics of the study population were collected. The primary and secondary patency rates were defined as the time between stent deployment and the first intervention and second intervention, respectively. Patency and re-intervention rates were estimated using Kaplan-Meier survival analysis. Results: This study included 50 patients with thigh AVGs; mean age was 50.5± 15.5 years; 52% were female; 80% were black; and 90% had hypertension. The main indication for stenting was thrombosis due to venous anastomosis stenosis (74%). The number (mean ± SD) of stents deployed was 1.24 ± 0.8. The primary patency rate at three months and one year was 58.7% and 30.7%. In comparison, the secondary patency rate at three months and one year was 68.2% and 40.7% (p=0.04) Conclusions: Thigh AVG stenting can be successfully used to improve the overall patency rates of failing AVGs.

Long-term patency rate of the translocated autologous saphenous vein versus prosthetic material in vascular access surgery for haemodialysis and parenteral nutrition

2021 ◽  
pp. 112972982110131
Author(s):  
Wouter Driessen ◽  
Wilbert van der Meijden ◽  
Geert Wanten ◽  
Frank van Hoek
Keyword(s):  
Parenteral Nutrition ◽  
Vascular Access ◽  
Saphenous Vein ◽  
Patency Rate ◽  
Primary Patency ◽  
Prosthetic Material ◽  
Secondary Patency ◽  
Kaplan Meier ◽  
Significant Difference

Objective: To evaluate the long-term patency rate of the arteriovenous angioaccess (AVA) with interposition of either autologous or prosthetic material as a last option for vascular access in the upper extremity. Methods: This is a retrospective chart review study of all patients who received an AVA with autologous saphenous vein (SV Group, n = 38) or prosthetic material (PTFE Group, n = 25) as a conduit from the year 1996 to 2020 in the Radboud University Medical Center (Radboudumc). Data were retrospectively extracted from two prospectively updated local databases for vascular access, one for haemodialysis (HD) and one for parenteral nutrition (PN). When required, the medical records of each patient were used. Data were eventually collected anonymously and analysed in SPSS 25. Kaplan-Meier life-tables were used for the statistical analysis. Results: Primary patency at 12 and 48 months was 30% and 20% in the SV group and 45% and 14% in the PTFE group. No significant difference was shown in the median primary patency rate ( p = 0.715). Secondary patency at 12 and 48 months was 63% and 39% in the SV group and 55% and 19% in the PTFE group. This was considered a significant difference in median secondary patency in favour of the SV with 41.16 ± 17.67 months against 13.77 ± 10.22 months for PTFE ( p = 0.032). The incidence of infection was significantly lower in the SV group ( p = 0.0002). A Kaplan-Meier curve could not detect a significant difference in secondary patency between the access for haemodialysis and the access for parenteral nutrition. The secondary patency of the SV in parenteral nutrition access, was significantly higher when compared with PTFE ( p = 0.004). Conclusion: The SV can be preferred over PTFE when conduit material is needed for long-term vascular access for HD or PN treatment due to its higher secondary patency and lower infection risk.

Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation

2019 ◽  
Vol 21 (1) ◽  
pp. 55-59
Author(s):  
Gabriel Lopez-Pena ◽  
Javier E Anaya-Ayala ◽  
Ramon Garcia-Alva ◽  
Lizeth Luna ◽  
Rene Lizola ◽  
...  
Keyword(s):  
Axillary Artery ◽  
Infectious Complications ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Endovascular Recanalization ◽  
Arteriovenous Grafts ◽  
The Right ◽  
Stage Renal Disease

Objective: The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. Methods: This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients’ demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. Results: Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). Conclusion: Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.

Long-term results of endovascular treatment for arteriovenous dialysis access thrombosis in 143 patients: A single center experience

2019 ◽  
Vol 20 (5) ◽  
pp. 545-552
Author(s):  
Yunus Yilmazsoy ◽  
Umut Ozyer
Keyword(s):  
Primary Patency ◽  
Long Term Results ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Thrombolytic Treatment ◽  
Technical Success Rate ◽  
Arteriovenous Fistulas ◽  
Large Patient ◽  
Arteriovenous Grafts

Objective: This study aimed to determine the long-term patency duration and rate of thrombosis of autologous arteriovenous fistulas and synthetic grafts treated with endovascular methods in a large patient population. Methods: A total of 144 arteriovenous accesses (37 radiocephalic, 51 brachiobasilic, 41 brachiocephalic, and 15 femorofemoral) from 143 patients were included in the study. A total of 304 endovascular thrombolytic treatment procedures were performed for 94 (65%) arteriovenous fistula and 50 (35%) arteriovenous graft accesses. Results: The procedural technical success rate was 98.7%. The mean follow-up duration was 32.5 (range, 3–132) months. The primary patency rates for arteriovenous fistulas and arteriovenous grafts were 78% and 78% at 6 months, 66% and 63% at 1 year, and 45% and 0% at 36 months, respectively. The assisted primary patency rates for arteriovenous fistulas and arteriovenous grafts were 82% and 84% at 6 months, 71% and 69% at 1 year, 51% and 29% at 36 months, and 30% and 1% at 60 months, respectively. The secondary patency rates for arteriovenous fistulas and arteriovenous grafts were 94% and 93% at 6 months, 85% and 85% at 1 year, 58% and 59% at 36 months, and 47% and 48% at 60 months, respectively. Conclusion: Although the primary patency durations for arteriovenous fistulas were better after endovascular thrombolytic treatment than those for arteriovenous grafts, the long-term outcomes of assisted primary and secondary patency durations after repeated procedures were similar for both types of arteriovenous accesses.

Long-term patency and comparisons of venous outflow in hemodialysis forearm arteriovenous grafts

Vascular ◽  
2021 ◽  
pp. 170853812110125
Author(s):  
Peng Miao ◽  
Zheng-Li Tan ◽  
Ran Tian ◽  
Chen-Liang Yao ◽  
Xin Chen ◽  
...  
Keyword(s):  
Graft Patency ◽  
Primary Patency ◽  
Secondary Patency ◽  
Venous Outflow ◽  
Venous Anastomosis ◽  
Central Venous Stenosis ◽  
Significant Difference ◽  
Arteriovenous Grafts ◽  
Observation Period

Introduction This retrospective study investigated the factors and the effects of different venous outflows on forearm arteriovenous graft patency. Methods The venous outflow sites included basilic, cephalic, median antecubital, and deep veins. Comparisons among multiple groups were analyzed. Findings A total of 179 patients with forearm loop arteriovenous grafts met the inclusion criteria. Of these, 72 were basilic, 48 were cephalic, 44 were median antecubital, and 15 were deep. The median observation period was 19 months. The survival rate was 84.9% at 24 months and 78.2% at 48 months. Primary, secondary, and assisted primary patency rates for all arteriovenous grafts were 48.9%, 72.4%, and 68.4% at 12 months; 13.8%, 33.9%, and 23.6% at 24 months; and 0.6%, 4.6%, and 2.3% at 48 months, respectively. Differences in primary patency were statistically significant compared with those of secondary and assisted primary patency ( P <  0.05). Primary patency rates for cephalic, median antecubital, basilic, and deep were 47.9%, 48.6%, 47.7%, and 40.0% at 12 months and 12.5%, 13.9%, 22.7%, and 0% at 24 months, respectively. Secondary patency rates for cephalic, median antecubital, basilic, and deep were 75.0%, 69.4%, 75.0%, and 73.3% at 12 months and 39.6%, 30.6%, 38.6%, and 13.3% at 24 months, respectively. There was no significant difference in primary thrombosis among basilic, cephalic, median antecubital and deep. There were no significant differences observed in primary or secondary patency rates among all the groups. Stenoses in the venous anastomosis and outflow vein were frequently observed in all types of arteriovenous grafts. Central venous stenosis was most commonly seen in deep (26.67%). On average, 1.9 interventions per patient were performed on the graft to maintain function. Conclusion Different venous outflow selections were not associated with long-term patency and the occurrence of thrombosis in hemodialysis forearm loop arteriovenous grafts.

Comparison between autogenous brachial–brachial upper-arm elevated direct arteriovenous fistulas and prosthetic brachial-antecubital indirect forearm arteriovenous grafts

2021 ◽  
pp. 112972982110180
Author(s):  
Hyokee Kim ◽  
Sanghyun Ahn ◽  
Minseob Kim ◽  
Chris Tae Young Chung ◽  
Kwang woo Choi ◽  
...  
Keyword(s):  
Postoperative Bleeding ◽  
Primary Patency ◽  
Secondary Patency ◽  
Complication Rates ◽  
Bleeding Rate ◽  
Arteriovenous Fistulas ◽  
Brachial Vein ◽  
Arteriovenous Grafts ◽  
The Individual ◽  
Better Than

Objectives: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines recommend forearm arteriovenous grafts (AVGs) as an alternative procedure to transposed basilic vein fistulas for providing secondary access during hemodialysis. Recently, autogenous elevated brachial-brachial vein fistulas (BVE) have become increasingly popular. The aim of this study was to compare the outcomes of BVE and forearm loop AVG (AVG) for secondary access in hemodialysis. Methods: We retrospectively reviewed the medical records of patients who had received a BVE or forearm AVG at a single center from January 2015 to April 2019. In total, 19 BVE were created via two-stage operations and two via a one-stage operation; 53 forearm AVG’s were performed. Results: The AVG group was twice as likely to suffer loss of primary patency compared with the BVE group (odds ratio [OR], 2.666; 95% confidence interval [CI], 1.108–6.412; p = 0.029) per the multivariate analysis. The primary patency and primary assisted patency of the BVE group were superior those of the AVG group, except for secondary patency ( p = 0.02, p = 0.07, p = 0.879, respectively). In subgroup analysis, there were no significant differences in primary, primary assisted, or secondary patency between AVG and BVE when brachial vein was used for AVG outflow. In addition, no significant differences were noted regarding the infection rate (12.5% vs 12.3%, p = 0.331, severity >0), postoperative bleeding rate (14.5% vs 3.5%, p = 0.191, severity >1), early thrombus rate (0.0% vs 10.5%, p = 0.122), and early failure rate (7% vs 4.8%, p = 0.591). Conclusions: The primary patency and primary assisted patency rates of BVE were significantly better than those observed in AVGs, but the complication rates were similar. The appropriate procedure to provide vascular access should be determined by the individual patient’s condition and the surgical skill of the operating surgeon.

Long-term outcomes of anterior chest wall arteriovenous graft with polyurethane

2021 ◽  
pp. 112972982110122
Author(s):  
Megumi Shimasaki ◽  
Hiromu Rachi ◽  
Kimitoshi Shiratori ◽  
Seiko Takanohashi ◽  
Satoko Uyama ◽  
...  
Keyword(s):  
Chest Wall ◽  
Patency Rate ◽  
Formation Rate ◽  
Anterior Chest Wall ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Long Term Outcomes ◽  
Secondary Patency Rate

Background: Anterior chest wall arteriovenous graft (ACWAVG) is one option for haemodialysis patients when vessels of the upper extremities become exhausted. We report here the long-term outcomes of ACWAVG with polyurethane. Methods: From April 2005 to October 2015, nine ACWAVGs with polyurethane grafts were created. We observed patients until April 2019 and evaluated graft patency, interval from operation to first cannulation, and numbers of interventions and complications. Results: Primary patency rate and secondary patency rate of 6, 12 and 24 months were 55.3%, 33.3%, 33.3% and 77.8%, 55.6%, 55.6% respectively. Mean interval from operation to first cannulation was 3 days. Infection rate and kinking formation rate were slightly higher than previous reports of ACWAVGs with expanded polytetrafluoroethylene (ePTFE). However, one patient was able to keep using a single graft for 166 months with multiple interventions. Conclusions: Slight disadvantage are seen with patency rate and complication rate in polyurethane ACWAVG compare to ePTFE. However, when early cannulation is required, polyurethane is worth to consider for creating ACWAVG.

Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 466-472 ◽  
Author(s):  
Chia-Hsun Lin ◽  
Yen-Yang Chen ◽  
Chai-Hock Chua ◽  
Ming-Jen Lu
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Target Lesion ◽  
Primary Patency ◽  
Anastomotic Stenosis ◽  
Secondary Patency ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Venous Anastomosis ◽  
Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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