Arterio-arterial prosthetic duct (AAD) as a vascular access in hemodialysis

Vascular access (VA) is mainly a problem confronting patients undergoing hemodialysis (HD). In some cases, peripheral veins are damaged or thrombosed because of repeated vein punctures and subsequent thrombophlebitis or accompanying ailments like diabetes or other kinds of vasculitis, making the use of conventional VA methods unsuitable. In this study, we present our experience using a synthetic vascular graft as an arterio-arterial duct (AAD) in the upper arm of patients undergoing HD, in whom other procedures had failed. In this procedure, we used a synthetic vascular prosthesis of polytetrafluoroethylene(ePTFE) (Gore-Tex^®) or Vasculink^® as an AAD, subcutaneous in the media aspect of the upper arm. HD was performed for this duct. Twenty patients were selected in whom all other VA means had failed. Patient age ranged from 33–83 yrs. In two patients (12%), early graft thrombosis was the cause of failure. In the remaining 14 patients (87%), a suitable flow was established. In another two patients, after several dialysis sessions the duct stopped functioning. We believe the reason for this malfunction was too much pressure on the graft to control bleeding due to the inadequate training of the HD personnel. The remaining 12 patients (75%) used the duct for >6 months. With this method, because we used only the artery for placing the conduit, complications relating to the vein such as limb ischemia, edema and venous hypertension did not prevail. On the other hand, because the conduit is an accessory duct, should it have become thrombosed, arterial flow to the limb would be unhindered. Therefore, we believe when all other conventional VA methods have failed, AAD is a suitable technique.