Kharazm Pezhman, Khajavi Sepehr, Aghili Alireza
Clinical Research Development Center, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
Clinical Research Development Center, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
Int J Surg Case Rep. 2024 Sep;122:110165. doi: 10.1016/j.ijscr.2024.110165. Epub 2024 Aug 13.
Hemodialysis is the most prevalent type of Renal Replacement Therapy in end stage renal disease patients. Arterio-venous fistulas/grafts and central venous catheters are the most prevalent vascular accesses. But in some patients these options are not feasible because of different reasons. In such cases arterio-arterial grafts may be a viable option to provide vascular access. In this study we present a case of axillary artery arterio-arterial graft.
A 66-year-old patient was scheduled for arterio-arterial graft implantation following failure of multiple previous vascular accesses. An 8 mm ringed PTFE graft was implanted in loop fashion subcutaneously in left anterior chest wall and anastomosed to transected ends of the axillary artery. Post-operative period was unremarkable and the graft was used for hemodialysis successfully for a period of 8 months.
Arterio-arterial grafts can provide a flow rate up to 400 ml per minute for hemodialysis. Although the risk of steal syndrome is minimal in this form of vascular access, but the risk of limb ischemia following graft thrombosis should be considered.
Arterio-arterial grafts may be the only available option for continued hemodialysis in some patients and any vascular surgeon should be familiar with this type of vascular access.
血液透析是终末期肾病患者中最常见的肾脏替代治疗方式。动静脉内瘘/移植物和中心静脉导管是最常见的血管通路。但在一些患者中，由于各种原因，这些选择并不可行。在这种情况下，动脉-动脉移植物可能是提供血管通路的可行选择。在本研究中，我们报告一例腋动脉-动脉移植物的病例。
一名66岁患者在先前多次血管通路失败后计划进行动脉-动脉移植物植入。将一段8毫米带环的聚四氟乙烯移植物以袢状方式皮下植入左前胸壁，并与腋动脉的横断端吻合。术后过程顺利，该移植物成功用于血液透析8个月。
动脉-动脉移植物可为血液透析提供高达每分钟400毫升的血流量。虽然这种血管通路形式发生窃血综合征的风险极小，但应考虑移植物血栓形成后肢体缺血的风险。
在某些患者中，动脉-动脉移植物可能是继续进行血液透析的唯一可行选择，任何血管外科医生都应熟悉这种血管通路。
