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Successful Use of Arteriovenous Graft for Hemodialysis Access After Left Ventricular Assist Device Placement
Katherine Toma1, Jacob S Stevens1, Nicholas J Morrissey2
1Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY.
Insights
Arteriovenous grafts (AVGs) offer a viable solution for long-term dialysis access in patients requiring kidney replacement therapy after left ventricular assist device (LVAD) implantation. These grafts demonstrated durability and reduced reliance on dialysis catheters in a small patient series.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Access
Background:
- Kidney replacement therapy (KRT) is necessary for up to one-third of patients post-left ventricular assist device (LVAD) implantation.
- Establishing durable vascular access for long-term hemodialysis in LVAD patients remains a clinical challenge.
Observation:
- This study reports on three patients with LVADs who received arteriovenous grafts (AVGs) for KRT.
- Successful long-term AVG use was observed, with one graft functioning for over two years.
- Two patients required AVG removal due to infection, but subsequent AVG placement was successful.
Findings:
- AVGs proved to be a viable option for dialysis access in this cohort of LVAD patients.
- AVG use significantly decreased the need for dialysis catheters, with catheter use ranging from 6.5% to 27% of total KRT duration.
- The time to first successful AVG use was within 40 days post-placement.
Implications:
- Arteriovenous grafts represent a promising solution for managing vascular access in complex LVAD patient populations requiring hemodialysis.
- Further research into AVG management and infection prevention in LVAD patients is warranted.
- This approach may improve the quality of life and reduce complications associated with temporary dialysis access in LVAD recipients.
Abstract:
Kidney replacement therapy is required in up to one-third of patients after left ventricular assist device (LVAD) placement. A subset of these patients requires long-term maintenance hemodialysis and therefore needs durable vascular access but the ideal access in such patients has not been established. We present a series of 3 patients in whom arteriovenous grafts (AVGs) were successfully used for long-term kidney replacement therapy after LVAD placement. The maximum time from AVG placement to first successful AVG use was 40 days, and the longest AVG use duration was more than 2 years. 2 patients required AVG excision due to infection but both had successful placement of a second AVG. Total time on kidney replacement therapy was 993, 1,055, and 956 days for the 3 cases, of which dialysis catheter use was required for only 23%, 6.5%, and 27%, respectively. These cases suggest that AVG placement is a viable option for dialysis access in patients with LVADs.
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