Prosthetic brachial artery-external jugular vein arteriovenous grafts as a novel option for hemodialysis access: A case report.

Following the exhaustion of all conventional hemodialysis access options in the upper extremities, a prosthetic arteriovenous loop was performed between the brachial artery (BA) and the external jugular vein (EJV) as a novel access option for hemodialysis in the present case report. During the procedure, a polytetrafluoroethylene graft was anastomosed to the BA and the EJV, and looped on the upper limb. The safety and reliability of BA-EJV access was evaluated by determining the complications, patency and intervention rates. The patient was then followed up for 20 months. The graft became thrombosed 20 months after the placement. There were no complications, such as infection, bleeding or aneurysmal lesions. Overall, the present study demonstrates that hemodialysis via BA-EJV access represents an unusual, yet effective and safe procedure, which may be conducted with acceptable complications and patency rates.

The United Kingdom and Ireland experience of the Haemodialysis Reliable Outflow graft for vascular access.

OBJECTIVES:: To describe the UK and Ireland experience of the Haemodialysis Reliable Outflow graft in complex vascular access. DESIGN:: Observational, multi-centre case series. METHODS:: Data from any patient undergoing Haemodialysis Reliable Outflow graft were collected from eight UK and one Irish centre. Any Haemodialysis Reliable Outflow procedure between July 2013 and May 2016 was included. Demographics, primary and secondary patency rates, and complications were analysed. RESULTS:: A total of 52 patients underwent Haemodialysis Reliable Outflow graft insertion. Median age was 55 (20-86) years, 24 (46%) were male and 66% were Caucasian. Median follow-up was 290 (10-966) days and patient survival was 41/52 (79%). In total, 48 procedures were in the upper limb with 39 using the brachial artery as inflow (75%). The internal jugular vein and subclavian vein were most frequently used as access for outflow insertion. Primary patency rates at 6, 12, and 24 months were 51.2% (95% confidence interval, 38.8%-67.4%), 40.9% (95% confidence interval, 28.7%-58.2%), and 33.4% (95% confidence interval, 21.3%-52.5%), respectively. Secondary patency rates at 6, 12, and 24 months were 84.8% (95% confidence interval, 75%-95.9%), 76.5% (95% confidence interval, 64.5%-90.6%), and 70.6% (95% confidence interval, 56%-88.9%), respectively. There were 65 surgical and 49 radiological interventions resulting in 2.30 interventions per year to retain patency. Complications included four infections and two episodes of steal syndrome. CONCLUSION:: The Haemodialysis Reliable Outflow graft provides acceptable 12-month secondary patency rates and acceptable complication rates in a UK and Ireland multi-centre series of complex access patients. Haemodialysis Reliable Outflow should be considered in patients with central pathology as a potential alternative to lower limb grafts and long-term central venous catheters.