Preservation of hemodialysis access with central obstruction

Abstract

To salvage the arteriovenous grafts in limbs with brachio-axillary-subclavian vein stenosis/occlusion and to avoid the need of subclavian/jugular catheter for temporary dialysis, the following management and preventive measures were adopted. Thirty-eight patients (17 M, 21 F), mean age of 59 years, underwent successful brachio-jugular and jugular-jugular bypasses for brachio-axillary-subclavian and brachiocephalic stenosis/thrombosis not amendable with balloon angioplasty. After a mean follow-up of 42 months, the venous bypass and arteriovenous graft (AVG) remain functional without arm swelling in 32/38 (84.2%) of the patients. A prospective randomized comparison of early AVG cannulation (<3 days) and late cannulation (> 10 days) following AVG placement showed no statistical difference in 36 patients (17 M, 19 F) equally divided into two groups (n = 18). The determinant parameters used for assessment of AVG were compression time for bleeding control, venous back pressure of AVG, hematoma, pseudoaneurysm, infection, and thrombosis of AVG. Venous bypass that circumvents venous outflow occlusion of limb with AVG is durable and effective in AVG preservation and reduction of the limb swelling. Early cannulation of AVG is plausible and without added risks. Subclavian and jugular catheter for temporary dialysis can be avoided.