Arterioarterial prosthetic loop: a new approach for hemodialysis access

Area of Science:

• Vascular Surgery
• Nephrology
• Dialysis Access

Background:

• Patients requiring hemodialysis often face challenges with traditional vascular access creation, such as arteriovenous fistulas or grafts, due to inadequate vascular conditions.
• Alternative access methods are crucial for this patient population to ensure effective and continuous renal replacement therapy.

Purpose of the Study:

• To evaluate the efficacy and safety of the arterioarterial prosthetic loop (AAPL) as a novel vascular access for hemodialysis.
• To assess the feasibility of using the proximal axillary or femoral artery for AAPL creation in patients with challenging vascular anatomy.

Main Methods:

• A prospective study involving 34 patients who received 36 AAPLs (31 axillary chest, 5 femoral) between 1996 and 2004.
• The procedure involves ligating the artery between anastomoses to direct flow through the prosthetic loop, with data collected prospectively.

Main Results:

• Primary indications for AAPL included unsuitability of deep veins (64%) and steal syndrome (11%).
• At 1 year, primary patency was 73% and secondary patency was 96%. At 3 years, these rates were 54% and 87%, respectively.
• Over 11,000 hemodialyses were performed with proven efficiency, and the intervention rate for maintaining AAPL function was low (0.47 procedures/patient-year).

Conclusions:

• The arterioarterial prosthetic loop (AAPL) is a practical and effective alternative for hemodialysis vascular access.
• It is particularly beneficial for carefully selected patients who cannot undergo conventional access procedures.
• The axillary chest AAPL approach is recommended due to its favorable outcomes.