Farooq Ahmad Ganie*, Mohd Yaqoob Khan, Syed Mohsin Manzoor, Ghulam Nabi Lone and Rouf Gul
Department of Cardiovascular and Thoracic Surgery, SKIMS, Soura, IndiaFulltext PDF
Background: A large group of patients with exhausted veins native arteriovenous fistula creation becomes is not possible and one has to consider the alternate methods of vascular access the prosthetic graft is an alternative with acceptable results.
Objective: To study the patency rates and complications associated with vascular access the arteriovenous prosthetic graft for hemodialysis. As native arteriovenous fistulas have been shown to be the superior means of repeated vascular access for hemodialysis.
Methods: The prosthetic graft was interposed between the deep vein (venous end) and to brachial or radial artery (arterial end) and was seated subcutaneously in the forearm after tunneling it through by means of a mid-forearm incision. Each patient was given a handmade diagram depicting, an inflow arterial and outflow venous limbs for the knowledge and exact cannulation by the hemodialysis staff.
Results: All the 30 patients were already on hemodialysis either on a neck line or a peripheral long line. (T) The mean operative time was 56 min (± 10 min).
All the 30 procedures were carried out without any bothersome intraoperative complication(s). Four (13%) patients required temporary gauze packing to tackle puncture bleeds in the graft material. Remaining 26 (86%) patients did not have any needle puncture bleeding. None (0%) of the patients had any major anastomotic bleeding or leaks on table.
On the next day of assessment, 2 (6.6%) patients had a small perianastomotic hematoma which required no surgical intervention. Six (20%) of the patients had cellulitis of the forearm which resolved within a week without any complications. Three (10%) patients developed infection of the wound with 1 (3.3%) necessitating graft removal and angioplasty under regional anesthesia. Four (13%) patients required single thrombectomy of the graft while as 1 (3.3%) patient required second thrombectomy and low dose anticoagulation.
Conclusion: Some of the patients with exhausted veins native AV fistula creation become impossible and one has to consider the alternate methods of vascular access. We studied 30 such patients who were not ideal for native AV fistula creation. Instead we resorted to synthetic loop graft fistulas and evaluated them for surgical outcomes and clinical utility.
End stage renal disease; Hemodialysis; Vascular access; Arteriovenous
Ganie FA, Khan MY, Manzoor SM, Lone GN, Gul R. Arteriovenous Prosthetic Graft: An Alternative in Patients with no Vascular Access for Hemodialysis - Our Experience. Ann Cardiovasc Surg. 2020;3(1):1025..