P. Sanchez1, J. C. Duque1, g. klimovich2, H. Labove4, L. Martinez2, R. Vazquez-padron2, L. Salman3, M. Tabbara2 1University Of Miami,Medicine,Miami, FL, USA 2University Of Miami,Surgery,Miami, FL, USA 3University Of Miami,Interventional Nephrology,Miami, FL, USA 4University Of Miami,Miller School Of Medicine,Miami, FL, USA
Introduction:
Arteriovenous Grafts are created in the arm when there are no adequate veins for a fistula. The outflow vein is usually the axillary vein in order to match the outflow to a 6-8mm graft. Our technique involves using a 3.5-4 mm brachial vein and create a preliminary mid arm brachial artery to brachial vein arteriovenous fistula. This is followed with a graft extension involving ligation of the fistula and using the dilated, mature vein as the outflow in an end-to-end anastomosis.
Methods:
The study included 92 patients who underwent a Brachial- Brachial Arteriovenous Graft creation at the University of Miami or Jackson Memorial Hospital from 2008 to 2015. The effects of primary graft survival were determined using multivariate logistic regressions and Cox proportional hazard models adjusted for clinical and demographic covariates (age, gender, ethnicity, hypertension, diabetes, antiplatelet agents, statins, prior catheter use, history of previous AVF and graft size).
Results:
Neither primary nor secondary graft survival was significantly correlated with clinical and demographic covariates. Primary failure at one year (365 days) was 55.4% (51 patients) with a mean survival of 283 (±128) days. The most common intravascular intervention in primary graft survival was balloon angioplasty in 32 (64.0%), followed by thrombectomy 11 (22.0%) and finally surgical revision 7 (14.0%).
Conclusion:
Our results suggest that the technique of a brachial vein fistula, followed by graft extension can result in a durable access and preserves the axillary vein for future grafts.