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Proximalization of arterial inflow for treatment of hemodialysis access-induced distal ischemia.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2024 Oct; Vol. 80 (4), pp. 1090-1096.e1. Date of Electronic Publication: 2024 Jun 21. - Publication Year :
- 2024
-
Abstract
- Objective: Hemodialysis access-induced distal ischemia (HAIDI) is a known complication of hemodialysis (HD) access. Distal revascularization and interval ligation (DRIL) is the preferred treatment for HAIDI by many surgeons. Proximalization of arterial inflow (PAI) is a promising alternative technique that, unlike DRIL, preserves the native arterial inflow. The purpose of this study is to report our experience with PAI on a series of 64 patients.<br />Methods: This is a single-center, retrospective cohort study of patients with both arteriovenous (AV) fistulas and grafts who underwent PAI for HAIDI from 2017 to 2023. A 4 × 7 tapered polytetrafluoroethylene (PTFE) graft was used to connect HD access inflow to the axillary artery in the majority of cases. The primary outcome of the study is resolution of HAIDI (complete, partial, or no resolution). Secondary outcomes include functional patency (primary and secondary) and 30-day complications following PAI.<br />Results: Of the 71 patients identified to have had PAI between May 2017 to August 2023, seven were lost to follow-up. In total, 64 patients were included, with an average age of 65 years (standard deviation, 15 years), 59.4% (38/64) female, and 37.5% (24/64) African American. The study population was notable for numerous comorbid conditions including 95.3% (61/64) hypertension; 50% (32/64) coronary artery disease; 79.7% (51/64) diabetes; and 43.8% (28/64) smoking history. Following PAI intervention for HAIDI, 55 of 64 patients (85.9%) experienced complete resolution of ischemic symptoms; five of 64 patients (7.8%) had partial resolution; two of 64 patients (3.1%) had no resolution, and two of 64 patients (3.1%) had unknown resolution. Primary patency at 1, 12, and 24 months was 94%, 81%, and 71%, respectively. Secondary patency at 1, 12, and 24 months was 97%, 87%, and 84%, respectively. The 30-day complication rate was 10.9% (7/64), with five of 64 (7.8%) thromboses, one of 64 (1.6%) thrombosis and infection, and one of 64 (1.6%) upper extremity swelling secondary to central venous stenosis (resolved with angioplasty of central venous system). Failure rate due to thrombosis at 12 and 24 months was 14% (9/64) and 15.6% (10/64), respectively.<br />Conclusions: Our study, the largest case series of PAI to date, demonstrates that PAI is a reliable option for HAIDI intervention and has comparable safety and efficacy results to DRIL, despite the use of a synthetic graft. Furthermore, PAI has the added benefit of maintaining the native arterial pathway. Further investigation of PAI is warranted as a promising alternative to DRIL for HAIDI management.<br />Competing Interests: Disclosures None.<br /> (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Retrospective Studies
Female
Male
Middle Aged
Aged
Treatment Outcome
Time Factors
Polytetrafluoroethylene
Regional Blood Flow
Risk Factors
Upper Extremity blood supply
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular physiopathology
Graft Occlusion, Vascular therapy
Axillary Artery surgery
Axillary Artery physiopathology
Renal Dialysis
Arteriovenous Shunt, Surgical adverse effects
Ischemia physiopathology
Ischemia etiology
Ischemia therapy
Ischemia surgery
Vascular Patency
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 80
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38909917
- Full Text :
- https://doi.org/10.1016/j.jvs.2024.05.045