Reverse-loop upper arm arteriovenous graft for chronic hemodialysis

Area of Science:

• Vascular Surgery
• Nephrology
• Dialysis Access

Background:

• Standard upper arm arteriovenous grafts (AVGs) often connect the brachial artery to the axillary vein.
• This configuration can lead to underutilization of valuable upper arm veins, limiting options for future secondary fistula creation.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a reverse-loop configuration for upper arm arteriovenous grafts (AVGs).
• To assess the potential of this configuration to preserve venous capital for secondary fistula creation.

Main Methods:

• A retrospective analysis of seven patients who underwent reverse-loop upper arm AVG creation.
• Graft connection involved the brachial artery near the cubital fossa and looped distally to the basilic or deep brachial vein.
• Endpoints included interventions, thrombosis, and loss of access.

Main Results:

• 100% AVG patency was observed over a median follow-up of 10.0 months.
• Patients achieved target hemodialysis doses, with median flow rates of 205.0 ml/minute at 1 month and 266.7 ml/minute at 3 months.
• Favorable dialysis venous pressures and peak systolic velocity ratios at artery-graft and vein-graft junctions were noted.

Conclusions:

• The reverse-loop upper arm AVG is a logical approach for patients with exhausted forearm vessels.
• This technique effectively preserves upper arm venous capital for potential future secondary fistula creation.