Axillary grafts for difficult hemodialysis access

Purpose: This study describes the largest reported experience to date with axillary artery-to-axillary vein or axillary artery-to-jugular vein polytetrafluoroethylene bridge fistulas for hemodialysis access. The purpose of the study was to determine the incidence of-complications and the durability of-the access to better determine the role of this procedure in the dialysis access algorithm. Methods: A single center's experience over a period of 5 years was retrospectively reviewed. Results: Twenty-six axillary grafts were placed in 24 patients. All but-one were used for dialysis. At the time of access creation, the patients had been undergoing dialysis for a mean of 77 months (range, 5 to 256 months), had had a mean of 9.4 previous access procedures, and had exhausted all arm sites. The life-table patency rate at 3 years was 60%. The incidence of infection and thrombosis were comparable with conventional arm bridge fistulas. Neither vascular steal phenomenon nor neurologic injury occurred in this series. Conclusions: Axillary artery-to-axillary vein or axillary artery-to-jugular vein polytetrafluoroethylene bridge fistula is an excellent and durable secondary access strategy. We recommend that it be used after exhaustion of conventional arm sites.