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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 1999 December;6(4):269-79

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English, Italian

Humeral-cephalic graft fistula in patients requiring hemodialysis

Gargiulo M., Freyrie A. *, Faggioli G. L. *, Tarantini S., Mosconi G. **, Santoro A. ***, Pace G. **, Spongano M. ***, Gessaroli M., Stella A. *

From the Vascular Unit, Ospedale degli Infermi, Rimini * Vascular Surgery Department of Service Policlinico Universitario S. Orsola, Bologna, Italy ** Department of Nephrology, Nephrology and Dialysis Service *** Division of Nephrology and Dialysis Ospedale M. Malpighi, Bologna, Italy


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Aim. Pros­thetic ­grafts for vas­cular ­access are pre­pared in ­patients ­with ­chronic ­renal insuf­fi­ciency (CRI) ­requiring vas­cular ­access for hemo­di­al­ysis ­when the sur­face and ­humeral ­veins of the ­upper ­limbs are not suit­able for the prep­ar­a­tion of a ­direct arter­i­ov­e­nous ­shunt. ­Between 1985 and 1995, a ­humeral/­cephalic ­graft (HCG) was pre­pared as the pro­ce­dure of ­choice in ­patients ­requiring hemo­di­al­ysis vas­cular ­access in the arm and pre­senting ­patency of the ­medial and/or prox­imal ­third of the ­cephalic ­vein in the arm. All ­grafts under­went reg­ular ultra­son­o­graphic Dop­pler con­trol (­every 3 ­months in the ­first ­year and ­every 6 ­months in sub­se­quent ­years). ­This ­study ­reports the imme­diate and ­late ­results of HCG and dis­cusses the ­value of ­this ­access as a ­means of pro­longing the ­mean hemo­di­a­lytic ­life of ­each arm.
­Methods. ­Twenty HCG in ­PTFE ­were pre­pared ­under ­local anes­thesia in 17 ­patients ­with CRI ­after a phleb­o­graphic ­study of ­both ­arms.
­Results. Intra­op­er­a­tive and imme­diate post­op­er­a­tive mor­tality was nil. Imme­diate ­patency was equiv­a­lent to 90% (­graft ­length <10 cm=100%, ­graft ­length >10 cm=84.6%); at 12 and 30 ­months ­patency (­life ­table anal­ysis) was respec­tively 75.5 and 39.3%. A new ­shunt was pre­pared in 8 ­cases of ­late throm­bosis: 4 homo­lat­eral ­humeral-axil­lary ­grafts (HAG), 3 con­tra­lat­eral HCG (­patients in ­whom it was pos­sible to pre­pare a homo­lat­eral HAG), 1 ­graft fis­tula at the ­groin. A ­graft ­which was >10 cm ­long was ­removed ­because of infec­tion ­after 8 ­months.
Con­clu­sions. HCG ­showed ­good imme­diate and ­late ­patency and guar­an­teed vas­cular ­access for tech­ni­cally ­simple hemo­di­al­ysis ­along the ­length of the ­graft and ­cephalic ­vein; in HCG ­with ­graft ­length <10 cm, hemo­di­al­ysis can be car­ried out ­using a ­dual ­access and the ­failure of HCG ­does not usu­ally pre­vent the sub­se­quent prep­ar­a­tion of a homo­lat­eral ­graft fis­tula ­with ­venous anas­tom­osis in an axil­lary ­site (HAG). HCG ­increases the ­mean hemo­di­a­lytic ­life of the ­upper ­limbs and ­should be ­used as ­first ­choice in ­patients ­requiring hemo­di­al­ysis in the arm who ­present ­patency of the ­median and/or prox­imal ­third of the ­cephalic ­vein.

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