A brachioaxillary AV graft is a vascular access created for patients requiring regular hemodialysis. It facilitates the efficient removal of waste products and excess fluids from the blood when kidneys are no longer functioning adequately. This durable pathway allows for repeated needle insertions necessary for dialysis treatments. The graft ensures a consistent and high flow of blood, a fundamental requirement for the hemodialysis machine to operate effectively.
Understanding the Brachioaxillary AV Graft
A brachioaxillary AV graft is an artificial conduit, typically made from synthetic material such as expanded polytetrafluoroethylene (ePTFE), surgically implanted in the arm. It creates a direct connection between the brachial artery in the upper arm and the axillary vein, a larger vein situated deeper in the shoulder and upper chest.
The design of this graft can be straight or, less commonly, a loop configuration, depending on the patient’s anatomy. The graft acts as a bridge, bypassing smaller, more fragile veins that might not withstand the repetitive cannulation and high blood flow rates required for dialysis.
Why This Graft is Essential for Dialysis
The brachioaxillary AV graft is necessary for individuals with End-Stage Renal Disease (ESRD) requiring hemodialysis. Hemodialysis demands consistent and high-volume access to the bloodstream to efficiently filter blood outside the body. Native arteriovenous fistulas (AVFs) are generally preferred due to their longevity and fewer complications. However, not all patients are suitable candidates for an AVF, or their fistulas may have failed after multiple attempts.
When a native fistula is not feasible or has failed, a synthetic AV graft, such as the brachioaxillary type, becomes a viable alternative. This graft provides a reliable, long-term vascular access option, particularly when other upper extremity access sites have been used or are compromised.
The Brachioaxillary AV Graft Placement Procedure
The placement of a brachioaxillary AV graft involves a surgical procedure that begins with thorough pre-operative assessment. This often includes imaging studies, such as vein mapping, to identify suitable arteries and veins for the graft placement and to assess their health and patency. The patient’s overall health and any existing medical conditions are also evaluated to ensure they are fit for surgery.
During the procedure, the patient receives regional or general anesthesia, and incisions are made in the upper arm and shoulder to expose the brachial artery and axillary vein. The synthetic graft material is then tunneled under the skin to connect these two vessels. The graft is surgically sewn to the brachial artery at one end and to the axillary vein at the other, creating a continuous circuit for blood flow. After the graft is securely in place and blood flow is confirmed, the incisions are closed with sutures. Patients usually remain in the hospital for a brief post-operative period for monitoring, typically for a day or two, to ensure no immediate complications arise.
Caring for and Living with Your AV Graft
Proper care of a brachioaxillary AV graft is important for its longevity and to prevent complications. Strict hygiene around the graft site is important, including washing the arm with soap and water daily and before each dialysis session. Avoid tight clothing, jewelry, or anything that could constrict the arm. Patients should also avoid sleeping on the graft arm and carrying heavy objects.
Regular monitoring for complications is essential, including vigilance for signs of infection like redness, warmth, swelling, or pus around the graft site. Aneurysms (bulges) or thrombosis (blood clots) require immediate medical attention. Steal syndrome, causing coldness, numbness, or pain in the hand, is another potential issue. During dialysis, specialized needles are inserted into the graft, and after treatment, firm but gentle pressure is applied to the needle sites until bleeding stops, followed by a sterile dressing. Regular follow-up appointments with a healthcare provider are necessary to assess graft function and address concerns.