| Theme | Progresses and Problems in Vascular Access for Hemodialysis | |
|---|---|---|
| Title | Indications for and clinical problems with atypical vascular access：axillary loop arterio-venous graft (necklace type) | |
| Publish Date | 2009/07 | |
| Author | Hiromi Hamada | Department of Surgery, Nikko-Memorial Hospital |
| Author | Joji Takada | Department of Surgery, Nikko-Memorial Hospital |
| Author | Taishi Nakashima | Kidney Center, Nikko-Memorial Hospital |
| Author | Noritomo Itami | Kidney Center, Nikko-Memorial Hospital |
| Author | Kazumasa Tsunoda | Noboribetsu-Memorial Hospital |
| [ Summary ] | The indications for, results from and clinical problems with the axillo-axillary shunt (necklace method) are discussed. This method is oneoption in cases where the appropriate vessels for access construction have been exhausted. This method can be applied in cases where the appropriate blood vessels are not available in the upper or lower extremities. It cannot however beapplied for patients with repeated infections, severe cardiac complications or those in which there is central vein stenosis or occlusion. For these reasons, pre-surgery verification of centralvein patency and evaluation of cardiac function are essential. Although long term patency is comparable to that with AVGs in other sites as well as deaths related to this method have not been reported, the decision to implement this method should bemade while recognizing that this is a method of last resort and with an understanding of the associated complications. It is also important to keep inmind the anastomotic site, choice of graft, and associated factors, when using this method. |
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