Arterio-arterial graft as vascular access in hemodialysis, a case report and review of literature

TL;DR

This paper presents a case where an arterio-arterial graft was successfully used for hemodialysis when other options failed.

Contribution

The paper introduces arterio-arterial grafts as a viable vascular access option in hemodialysis when traditional methods are not feasible.

Findings

An arterio-arterial graft provided successful hemodialysis for 8 months in a patient with multiple failed accesses.

Arterio-arterial grafts can achieve flow rates up to 400 ml per minute.

Limb ischemia following graft thrombosis is a significant risk with arterio-arterial grafts.

Abstract

Hemodialysis is the most prevalent type of Renal Replacement Therapy in end stage renal disease patients. Arterio-venous fistulas/grafts and central venous catheters are the most prevalent vascular accesses. But in some patients these options are not feasible because of different reasons. In such cases arterio-arterial grafts may be a viable option to provide vascular access. In this study we present a case of axillary artery arterio-arterial graft.

A 66-year-old patient was scheduled for arterio-arterial graft implantation following failure of multiple previous vascular accesses. An 8 mm ringed PTFE graft was implanted in loop fashion subcutaneously in left anterior chest wall and anastomosed to transected ends of the axillary artery. Post-operative period was unremarkable and the graft was used for hemodialysis successfully for a period of 8 months.

Arterio-arterial grafts can provide a flow rate up to 400 ml per minute for hemodialysis. Although the risk of steal syndrome is minimal in this form of vascular access, but the risk of limb ischemia following graft thrombosis should be considered.

Arterio-arterial grafts may be the only available option for continued hemodialysis in some patients and any vascular surgeon should be familiar with this type of vascular access.

•The number of ESRD patients requiring hemodialysis is increasing everyday•Arterio-arterial grafts are one of the last options to provide vascular success for hemodialysis•Limb ischemia following graft thrombosis is one of the most important complications of arterio-arterial grafts•Flow rates of more than 400 ml per minute could be problematic when the vascular access is an arterio-arterial graft

The number of ESRD patients requiring hemodialysis is increasing everyday

Arterio-arterial grafts are one of the last options to provide vascular success for hemodialysis

Limb ischemia following graft thrombosis is one of the most important complications of arterio-arterial grafts

Flow rates of more than 400 ml per minute could be problematic when the vascular access is an arterio-arterial graft

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