Increasing dialysis access options in lower extremity: Retroperitoneal approach for external iliac artery-vein arteriovenous graft

Benjamin D. Colvard, Javier E. Anaya-Ayala, Deborah Palacios-Reyes, Zulfiqar Cheema, Christopher J. Smolock, Mark G. Davies, Eric K. Peden

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Exhaustion of upper extremity dialysis access options is becoming more prevalent due to the longer survival of this patient population. In addition, central venous occlusive disease (CVOD) increases the risk of losing access viability in the ipsilateral extremity. Purpose: We describe a novel technique of lower extremity arteriovenous graft (AVG) placement in which the external iliac artery and vein are utilized, as illustrated in 2 selected cases. Methods: Two dialysis patients presented with exhausted upper extremity access options and bilateral intrathoracic CVOD. In patient 1, a venogram demonstrated complete occlusion of the left common iliac vein and severe stenosis of the right common femoral vein, rendering these unsuitable for access creation. In patient 2, with a history of peripheral arterial disease, an arteriogram revealed that the common and superficial femoral arteries were inadequate for access creation bilaterally. A retroperitoneal approach was utilized for a right external iliac artery and vein arteriovenous graft tunneled under the inguinal ligament to the anterior thigh. Results: Adequate thrill and uneventful postoperative course were observed in both cases. At 10 months, patient 1 has done well on hemodialysis without the need for further intervention. Patient 2 has only recently had the procedure and is not yet using her graft. Conclusions: As the number of patients requiring lower extremity vascular access increases, new surgical techniques will become available to handle the clinical and anatomic challenges encountered in this population.

Original languageEnglish (US)
Pages (from-to)365-368
Number of pages4
JournalJournal of Vascular Access
Volume12
Issue number4
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Iliac Vein
Iliac Artery
Dialysis
Lower Extremity
Transplants
Upper Extremity
Femoral Vein
Groin
Peripheral Arterial Disease
Femoral Artery
Thigh
Ligaments
Population
Blood Vessels
Renal Dialysis
Pathologic Constriction
Extremities
Survival

Keywords

  • External iliac artery and vein
  • Lower extremity hemodialysis access
  • Retroperitoneal arteriovenous graft

ASJC Scopus subject areas

  • Surgery
  • Nephrology

Cite this

Colvard, B. D., Anaya-Ayala, J. E., Palacios-Reyes, D., Cheema, Z., Smolock, C. J., Davies, M. G., & Peden, E. K. (2011). Increasing dialysis access options in lower extremity: Retroperitoneal approach for external iliac artery-vein arteriovenous graft. Journal of Vascular Access, 12(4), 365-368. https://doi.org/10.5301/JVA.2011.6452

Increasing dialysis access options in lower extremity : Retroperitoneal approach for external iliac artery-vein arteriovenous graft. / Colvard, Benjamin D.; Anaya-Ayala, Javier E.; Palacios-Reyes, Deborah; Cheema, Zulfiqar; Smolock, Christopher J.; Davies, Mark G.; Peden, Eric K.

In: Journal of Vascular Access, Vol. 12, No. 4, 10.2011, p. 365-368.

Research output: Contribution to journalArticle

Colvard, BD, Anaya-Ayala, JE, Palacios-Reyes, D, Cheema, Z, Smolock, CJ, Davies, MG & Peden, EK 2011, 'Increasing dialysis access options in lower extremity: Retroperitoneal approach for external iliac artery-vein arteriovenous graft', Journal of Vascular Access, vol. 12, no. 4, pp. 365-368. https://doi.org/10.5301/JVA.2011.6452
Colvard, Benjamin D. ; Anaya-Ayala, Javier E. ; Palacios-Reyes, Deborah ; Cheema, Zulfiqar ; Smolock, Christopher J. ; Davies, Mark G. ; Peden, Eric K. / Increasing dialysis access options in lower extremity : Retroperitoneal approach for external iliac artery-vein arteriovenous graft. In: Journal of Vascular Access. 2011 ; Vol. 12, No. 4. pp. 365-368.
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