Safety and efficacy of infraclavicular arterioarterial chest wall prosthetic loop graft for hemodialysis access: a review of 45 patients

Introduction
With raising the demand for hemodialysis (HD) owing to concomitant increased incidence of nephropathic disease, which has led to associated increased patients’ life expectancy in the past three decades, it becomes necessary to establish a secondary or a tertiary HD vascular access to overcome the exhausted peripheral veins and central venous occlusion.
Aims
Our case study reports midterm (24-month follow-up) results with infraclavicular arterioarterial loop graft and evaluates its efficacy and safety in construction of HD vascular access for patients with end-stage renal disease.
Material and methods
This was a prospective study. From December 2014 to December 2017, 45 patients with end-stage renal disease on chronic HD with exhausted all peripheral and central veins or were considered unsuitable for creation of arteriovenous fistula/graft owing to heart failure underwent arterioarterial chest wall prosthetic graft implantation for creation of HD vascular access. The data analysis was done using SPSS version 20.0 for Windows.
Results
The primary patency rates were 100, 97.7, 93, 77.5, and 73.7% at 6, 9, 12, 18, and 24 months, respectively. The secondary patency rates were 100, 85.7, and 66.6% at 6, 9, and 12 months, respectively, after successful thrombectomy in nine patients. There were 20 (44.4%) secondary variable procedures performed in 18 (40%) patients during follow-up period, with no procedure-related mortality or limb-threatening conditions being documented in our study.
Conclusion
Our case study reports a reasonable midterm patency rate, and complications associated with this pattern of vascular access show that infraclavicular arterioarterial loop grafts are a valid alternative option for complex patients. We advocate the use of this technique in patients with exhausted all vascular access possibilities in both upper extremities with central venous obstruction. We also indicate it in case of patients with cardiac insufficiency who could not tolerate long-term hemodynamic effect of arteriovenous fistula/graft.