Surgical treatment of hemodialysis-related central venous stenosis or occlusion: Another option to maintain vascular access

Abstract

Decompression of the femoral vein enables preservation of vascular graft patency and improves symptoms of venous hypertension.

Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: A prospective single-center experience

“…It has also been suggested that it is more cost-effective to create a new graft when several endovascular interventions at short intervals are necessary to maintain patency. 19 In patients with no remaining upper limb access options, the most commonly used alternatives are a axillary loop, long saphenous vein loop to the femoral artery, transposition to the popliteal artery, or a loop graft at the femoral triangle. A series of axillary loop accesses with a 12-month primary patency rate of 51% and a secondary patency rate of 80% at 18 months was recently reported.…”

“…Several complex (exotic, extra-anatomic) access procedures in patients with difficult vascular access problems have been described. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These options include axillary loops, axillaryaxillary arteriovenous grafts, internal jugular vein bypasses, superficial femoral vein transpositions, femorofemoral arteriovenous cross over bypasses, axillary artery to popliteal vein bypasses, and femoral artery to right atrium bypasses. 3,9 The arteriovenous axillary loop graft has been reported as a possible primary vascular access procedure when no other upper limb option is feasible.…”

2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis

“…5. Intervention should be the first choice for venous hypertension caused by central venous stenosis . However, intervention should be avoided in cases where the risk of vessel rupture by intervention is high.…”

Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

“…An alternative vascular access must be secured for continuing renal replacement therapy. Other options include repeated percutaneous transluminal balloon angioplasty with or without stent insertion, venous reconstruction, including a polytetrafluoroethylene axillary to the saphenous graft bypass [35], an atrial graft bypass [36], a switch to a lower-limb vascular access, or peritoneal dialysis.…”