The Axillo-Axillary Arteriovenous Graft: Technique and Outcomes in the Obese Patient

Objectives: In the last decade, surgeons are being increasingly challenged to provide vascular access for patients whose access options in the upper extremity have been expended. This situation is even more problematic in the morbidly obese patient. Previously, our group reported a high rate of infection and need for secondary interventions in obese patients with thigh AV grafts. We report a series of patients who underwent axillo-axillary AV access placement.
Methods: The purpose of this study is to present our technique and to evaluate our results, particularly as it relates to the obese patient. From 1998 to 2006, 34 axillo-axillary AV grafts were placed in 32 patients with ESRD. Obesity was defined as a BMI > 30 kg/m2 (n=11 patients/12 grafts). Median follow-up was 16 months. Kaplan-Meier life table analysis was utilized to determine outcomes of primary and secondary graft patency and patient survival for the entire cohort and for the obese versus non-obese patients; survival curves were compared using the log-rank test for equality over strata.
Results: The secondary patency rate was 59% at one year (median 18 months). The one-year survival was 69%. Comparison of the obese vs. non-obese cohorts demonstrated no statistically significant difference in one-year primary patency (36% vs. 10%, p=0.17), secondary patency (71% vs. 54%, p=0.14), or survival (79% vs. 65%, p=0.34).
Conclusions: These data show that axillo-axillary AV graft placement has acceptable outcomes and should be considered the tertiary vascular access of choice in the obese patient on hemodialysis.