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Axillary grafts for difficult hemodialysis access
1Duke University Medical Center, Durham, NC, USA.
Journal of Vascular Surgery
|September 1, 1996
Summary
Axillary bridge fistulas provide durable hemodialysis access when arm sites are exhausted. This study found comparable complication rates to conventional methods, making them a viable secondary access option.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Patients undergoing long-term hemodialysis often exhaust conventional arm access sites.
- Alternative access strategies are crucial for maintaining adequate dialysis treatment.
- Axillary polytetrafluoroethylene (PTFE) bridge fistulas represent a potential secondary access option.
Purpose of the Study:
- To evaluate the largest reported experience with axillary artery-to-vein PTFE bridge fistulas for hemodialysis.
- To determine the complication incidence and durability of this secondary access strategy.
- To clarify the role of axillary bridge fistulas in the dialysis access algorithm.
Main Methods:
- Retrospective review of a single center's experience over 5 years.
- Analysis of 26 axillary PTFE bridge fistulas placed in 24 patients.
- Assessment of patency, infection, thrombosis, and other complications.
Main Results:
- Twenty-six axillary grafts were placed, with 25 used for dialysis.
- Patients had a mean of 77 months of prior dialysis and 9.4 previous access procedures.
- Three-year life-table patency rate was 60%; infection and thrombosis rates were comparable to arm fistulas.
- No instances of vascular steal or neurologic injury were observed.
Conclusions:
- Axillary artery-to-vein PTFE bridge fistulas are an excellent and durable secondary access option.
- This procedure is recommended after conventional arm sites have been exhausted.
- Axillary bridge fistulas offer a reliable solution for patients with limited access options.