Brachial Artery to Axillary Vein Dialysis Graft Creation for Salvage After Failed Upper Extremity Dialysis Access

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

J Vasc Surg

Abstract

Objectives: Maintaining hemodialysis (HD) access can be challenging in patients with a history of multiple accesses in the ipsilateral extremity. Much effort has been directed at finding reliable alternative access, one of which being a brachial artery to axillary vein graft. Certain techniques have described the axillary vein as the point of outflow in arteriovenous graft (AVG) creation, but questions have been raised in relation to the precise anatomic location of the venous anastomosis. In this clinical case series, we report 20 patients who underwent brachial artery to anatomic axillary vein graft creation with venous outflow medial to the teres major for HD access following failed fistulas and recorded their primary and secondary patencies. Methods: This is a single-institution case series of patients undergoing dialysis graft creation from the brachial artery to the anatomic axillary vein operated on by a single practitioner from 1990 to 2020. The technique of axillary vein exposure required an infraclavicular incision with division of the pectoralis minor tendon. Patient demographics and comorbidities were recorded, and frequency distributions were constructed and presented in the form of percentages. Kaplan-Meier analyses were performed on (a) primary patency (n = 20), and (b) secondary patency (n = 13). Results: The primary patency of brachial artery to axillary vein grafts was 62% at 6 months, 45.7% at 12 months, and 17.1% at 24 months (Fig 1). The secondary patency was 79.3% at 6 months, 51% at 12 months, and 24% at 24 months (Fig 2). On average, patients undergoing this brachial artery axillary vein graft creation had 3.3 ± 0.56 interventions after AVG creation. Conclusions: Brachial artery to axillary vein grafts provide a proximal option for dialysis access when considering an access in the contralateral extremity or a HERO graft. As this technique has been performed in a small series, further data is needed to extrapolate outcomes on a prospective basis. [Formula presented] [Formula presented]

Volume

79

Issue

6

First Page

e180

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