Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study

Abstract

Vascular access failure causes significant morbidity among end stage renal failure patients. With the increased life expectancy and frailty of those patients, maintaining vascular access became a great challenge. In this study, we assess the short and midterm outcomes of infraclavicular arterio-arterial prosthetic loop (IAAPL) as vascular access for haemodialysis in frail patients who have exhausted conventional vascular access methods. A prospective observational study of 43 patients undergoing IAAPL was conducted in a single centre between May 2017 and March 2020. Primary, assisted primary and secondary patency rates were recorded in addition to complications and patient compliance with access. The achieved primary, assisted primary and secondary patency rates at 6 months are 87.5%, 95%, 97.5% respectively, at one year, corresponding rates were 75%, 83.3%, 94.4% and at 18 months they were 68.6%, 77.1%, 85.7% respectively. There was no procedure related mortality and life-threatening complications during the study period. So we can assume that infraclavicular AAPL is a safe and effective method of obtaining alternative vascular access for hemodialysis in frail patients for whom the conventional vascular access for hemodialysis is not suitable or contraindicated.