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Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices
Aditya Safaya1, Kalyani Bhuta1, Heena Rajdeo1
1Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
Annals of Vascular Surgery
|September 5, 2020
Summary
For patients with continuous flow left ventricular assist devices (CFLVADs) and kidney failure, a brachio-brachial arterio-venous graft (AVG) offers a durable and convenient dialysis access solution. This approach facilitates early cannulation and improves quality of life.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Medical Devices
Background:
- Renal dysfunction is common in patients with left ventricular assist devices (LVADs), necessitating renal replacement therapy (RRT).
- Continuous flow LVADs (CFLVADs) create unique hemodynamic changes, complicating long-term dialysis access selection for patients with limited life expectancy.
Observation:
- A 61-year-old male with a CFLVAD and renal dysfunction, previously on intermittent RRT via a nontunneled catheter, required permanent hemodialysis access.
- The patient presented with dialysis-dependent renal failure.
Findings:
- A right brachio-brachial arterio-venous graft (AVG) was surgically placed.
- The AVG was successfully cannulated for hemodialysis on postoperative day 15 and remained functional at 18 months.
Implications:
- Arteriovenous grafts (AVGs) represent a convenient and durable option for dialysis access in LVAD patients.
- AVG placement facilitates early cannulation, reduces reliance on indwelling catheters, and may decrease secondary interventions, hospitalizations, and costs, thereby enhancing patient quality of life.
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