S NAYAR 1, S THOMAS 1, D FERNANDES 1, B PAWAR 1, S KODGIRE 1, P GEORGE 1,M HAMILTON2, C SAJIV 1
1Alice Springs Hospital, Alice Springs, Australia, 2Royal Darwin Hospital, Darwin, Australia
Aim: To evaluate the outcome of an axillary-axillary (AA) interarterial (IA) access which is a novel vascular access in haemodialysis patients who have exhausted all conventional arteriovenous (AV) access options.
Background: In haemodialysis patients, native arteriovenous fistulas and arteriovenous grafts are the first and second choice for haemodialysis access, respectively. An AA IA positioned on the chest is an alternative permanent dialysis access however experiences with this access are limited.
Methods: A retrospective review of patients who underwent placement of an AA IA access was done. Patients were clinically assessed every three months.
Results: All 5 were Aboriginal patients with mean age of 49.5 yrs. 4/5 patients were female. Mean duration of dialysis was 13.2 yrs. 2 patients had diabetic nephropathy, 2 patients had glomerular nephritis and 1 patient had reflux nephropathy as the cause of their End Stage Renal Disease. All the patients had exhausted vascular access with central venous occlusion. 6 mm flixene loop grafts were implanted with end to end anastomosis to axillary artery. There were no early post-operative complications. Out of 5, only one graft failed due to late access thrombosis at 753 days. Primary patency of 80 % achieved at 2 yrs. Grafts were maintained for haemodialysis at a mean access flow of 150 to 200 mL/min and not used for any drug administration. Adequate dialysis could be achieved with a mean Kt/V value of 1.4. There were no episodes of graft infections and no endovascular interventions required.
Conclusions: This analysis has shown that the AA IA loop access could be considered in dialysis patients who have exhausted all conventional AV access options.
Dr. Sajith Nayar is a renal physician at Alice Springs Hospital. Obtained Fellowship from Royal Australasian College of Physicians in Australia and Royal College of Physicians in UK. He has been engaged in Aboriginal Health care and research for last 6 years in Northern territory. He has been involved in collaborative general nephrology service, renal replacement therapy and renal transplantation care from both local and remote communities. Department being one of the largest interventional nephrology centre, he has gained knowledge and skills in the field of interventional nephrology for the endovascular management of dysfunctional vascular access in remote Central Australia.