Improved patency of prosthetic arteriovenous grafts with an acute anastomotic angle and flow diffuser

• Published in: Journal of vascular surgery Vol. 37; no. 5; pp. 1032 - 1035
• Main Authors: Hakaim, Albert G., Nalbandian, Matthew N., Heller, Jennifer K., Chowla, Arun C., Oldenburg, W.Andrew
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2003; Elsevier
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical - instrumentation; Arteriovenous Shunt, Surgical - instrumentation; Axillary Vein - physiology; Axillary Vein - surgery; Biological and medical sciences; Blood Flow Velocity - physiology; Blood Vessel Prosthesis; Brachial Artery - physiology; Brachial Artery - surgery; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Prosthesis Design; Renal Insufficiency - mortality; Renal Insufficiency - physiopathology; Renal Insufficiency - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Treatment Outcome; Vascular Patency - physiology; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Human; Prognosis; Treatment; Angle; Follow up study; Surgery; Homograft; Graft; Surgical arteriovenous anastomosis; Technique
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2003.187

Objective: Conventional end-to-side anastomosis to establish venous outflow for prosthetic arteriovenous grafts often requires operative patch angioplasty within 1 year because of venous stenosis. Rather than conventional venous anastomosis, a modified end-to-side anastomosis at a 15-degree angle with a flow diffuser was constructed. Such diffusers allow decreased flow velocity and increased pressure, inhibiting boundary layer separation. Methods: Ten brachial artery to axillary vein 6 mm straight se-polytetrafluoroethylene prosthetic arteriovenous grafts were created with this technique. Patients included 6 men and 4 women (mean age, 66.4 years; range, 54-80 years), all with renal failure and a history of diabetes. The degree of stenosis at the venous anastomosis was determined with duplex scanning at intervals of 6 months. Analysis of survival and cumulative primary patency estimates were determined with the Kaplan-Meier method. Results: Primary cumulative patency estimate of 100% for the modified group at 18 and 24 months was significantly greater than that for age-matched historic control fistulas with the conventional end-to-side anastomosis (n = 20): 18 months, 32%; 24 months, 32% (P <.05). Although venous stenosis could not be quantitated for thrombosed conventional fistulas, modified anastomoses had minimal stenosis at 24 months: mean area reduction, 30% (range, 20%-45%). Conclusion: Incorporation of a flow diffuser and a 15-degree anastomotic angle significantly increases patency of prosthetic brachial artery to axillary vein grafts. (J Vasc Surg 2003;37:1032-5.)