Hinojosa Carlos A, Anaya-Ayala Javier E, Lopez-Mendez Alejandra, Gomez-Arcive Zeniff, Laparra-Escareno Hugo, Cuen-Ojeda Cesar, Lizola Rene, Torres-Machorro Adriana
Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, Mexico City, Mexico.
J Artif Organs. 2017 Mar;20(1):57-61. doi: 10.1007/s10047-016-0927-4. Epub 2016 Oct 5.
Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.
浅表静脉耗竭以及存在胸内中央静脉闭塞仍然是建立血液透析通路的重大障碍；已有文献描述了复杂的动静脉移植物（AVG）构型。腋-髂动静脉移植物于1987年首次报道，很少有作者探讨过这种通路。我们评估了使用早期插管（EC）移植物Flixene™（美国新罕布什尔州哈德逊市Atrium™公司）构建这种AVG构型的经验。8例终末期肾病（ESRD）患者（75%为男性；平均年龄37±10岁）接受了使用Flixene™移植物的腋-髂动静脉移植物构建术；所有患者外周静脉均已耗竭，胸内中央静脉闭塞，股静脉条件不佳。在建立通路之前评估了腋动脉的流入和髂总静脉系统的流出情况。使用6毫米（mm）的EC移植物构建腋-髂总动静脉移植物，并在胸壁和腹壁进行隧道化。植入了8根移植物；放置后所有移植物均通畅。7例（88%）在72小时内成功用于血液透析，1例（12%）在96小时内成功用于血液透析。在平均6个月的随访期间，5例（62%）患者接受了血栓切除术，其中1例（12%）在静脉吻合处进行了球囊血管成形术，2例（25%）移植物因感染而被移除。其余移植物仍在发挥功能。未观察到高输出量心力衰竭、窃血综合征和静脉高压等并发症。在静脉耗竭、胸内中央静脉闭塞和腹股沟条件不佳的情况下，使用EC移植物构建腋-髂动静脉移植物是一种可行的动静脉通路选择，同时避免了中心静脉导管的使用。
