Efficacy of lower extremity arterio-arterial graft and literature review_West China Medical Journal

Authors：

LIU Sijie , BAO Xuedong ,  SHI Yaxue , MI Lanhua , WU Chang , FU Xinyi , ZHANG Huanyu

Department of Vascular Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200086, P. R. China;

Corresponding?author：

SHI Yaxue, Email: drshiyaxue@163.com

Keywords：

Arterio-arterial graft; hemodialysis access; central venous lesion

DOI：

10.7507/1002-0179.202606136

Video：

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Objective To summarize the efficacy of lower-extremity arterio-arterial graft (AAG). Methods A retrospective analysis was performed on the clinical data and follow-up outcomes of patients who received lower-extremity AAG in Longhua Hospital Shanghai University of Traditional Chinese Medicine between August 2015 and September 2021. Results A total of 7 patients with AAG were enrolled, with a mean age of (52.1±12.5) years, including 6 females. Six patients received common femoral artery-deep femoral artery AAG, and 1 patient received common femoral artery-superficial femoral artery AAG. All grafts were successfully cannulated for hemodialysis. The follow-up duration ranged from 2 to 77 months, with a mean of (31.6±26.9) months. No limb ischemia occurred during follow-up. Graft thrombosis developed in 6 patients, and stenosis was observed in 6 patients (including distal arterial anastomotic stenosis and cannulation site stenosis). Pseudoaneurysms formed in 4 patients, among whom 1 was complicated by local infection. The 2-year secondary access patency rate was 83.3%. Conclusions Lower-extremity AAG, especially common femoral artery-deep femoral artery AAG, is associated with a low incidence of distal limb ischemia and acceptable patency rates, which can prolong patients’ hemodialysis survival. However, pseudoaneurysms at cannulation sites remain a concern. This alternative access can be cautiously selected in clinical practice.

Citation： LIU Sijie, BAO Xuedong, SHI Yaxue, MI Lanhua, WU Chang, FU Xinyi, ZHANG Huanyu. Efficacy of lower extremity arterio-arterial graft and literature review. West China Medical Journal, 2026, 41(7): 1071-1076. doi: 10.7507/1002-0179.202606136 Copy

1.	中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
2.	Kundu S. Central venous disease in hemodialysis patients: prevalence, etiology and treatment[J]. J Vasc Access, 2010, 11(1): 1-7.
3.	Agarwal AK. Central vein stenosis[J]. Am J Kidney Dis, 2013, 61(6): 1001-1015.
4.	Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist’s perspective[J]. Semin Dial, 2007, 20(1): 53-62.
5.	Schmidli J, Widmer MK, Basile C, et al. Editor’s choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2018, 55(6): 757-818.
6.	Kukita K, Ohira S, Amano I, et al. 2011 update Japanese Society for Dialysis Therapy guidelines of vascular access construction and repair for chronic hemodialysis[J]. Ther Apher Dial, 2015, 19(Suppl 1): 1-39.
7.	Nakamura T, Suemitsu K, Nakamura J. Superficialization of brachial artery as effective alternative vascular access[J]. J Vasc Surg, 2014, 59(5): 1385-1392.
8.	Murakami M, Sakaguchi G, Mori N. Arteriovenous fistula combined with brachial artery superficialization is effective in patients with a high risk of maturation failure[J]. J Vasc Surg, 2017, 65(2): 452-458.
9.	Weyde W, Kusztal M, Go??biowski T, et al. Superficialization of the radial artery--an alternative secondary vascular access[J]. J Vasc Access, 2012, 13(4): 504-507.
10.	Ge W, Shi Y, Liu S, et al. Superficialization of dilated radial artery for vascular access: a case report[J]. J Vasc Access, 2023, 24(4): 818-820.
11.	Salgado OJ, Terán NA, Rosales B, et al. Subcutaneous transposition of the superficial femoral artery for arterioarterial hemodialysis: technique and results[J]. Artif Organs, 2008, 32(12): 969-973.
12.	Yasunaga C, Nakamoto M, Fukuda K, et al. Superficial repositioning of the artery for chronic hemodialysis: indications and prognosis[J]. Am J Kidney Dis, 1995, 26(4): 602-606.
13.	Nayman J. An arterioarterial shunt for use in haemodialysis[J]. Lancet, 1964, 1(7329): 365.
14.	Ali H, Elbadawy A, Saleh M. Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access[J]. J Vasc Surg, 2020, 72(1): 181-187.
15.	Talaiezadeh AH, Haghighi KE. Arterio-arterial prosthetic duct (AAD) as a vascular access in hemodialysis[J]. J Vasc Access, 2004, 5(3): 113-115.
16.	Bünger CM, Kr?ger J, Kock L, et al. Axillary-axillary interarterial chest loop conduit as an alternative for chronic hemodialysis access[J]. J Vasc Surg, 2005, 42(2): 290-295.
17.	Khafagy T, Regal S, ElKassaby M, et al. Early results of brachial arterio-arterial prosthetic loop (AAPL) for hemodialysis[J]. Eur J Vasc Endovasc Surg, 2016, 51(6): 867-871.
18.	Lei W, Ji J, Wang J, et al. Arterioarterial prosthetic loop as an alternative approach for hemodialysis access[J]. Medicine (Baltimore), 2015, 94(41): e1645.
19.	Zanow J, Kruger U, Petzold M, et al. Arterioarterial prosthetic loop: a new approach for hemodialysis access[J]. J Vasc Surg, 2005, 41(6): 1007-1012.
20.	Rahim AMAA, Bush A, Ahmed AAS, et al. Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study[J]. Pan Afr Med J, 2021, 40: 245.
21.	崔銳, 郝旭陽, 詹申, 等. 移植物動脈-動脈通路在血液透析中的應用效果[J]. 中華醫學雜志, 2024, 104(32): 3063-3066.
22.	劉思潔, 鮑雪東, 施婭雪, 等. 利用自體動靜脈內瘺創造血管條件建立前臂人工血管動靜脈內瘺 1 例[J]. 中國血管外科雜志(電子版), 2025, 17(3): 287-289, 291.
23.	米蘭化, 鮑雪東, 施婭雪, 等. 下肢動靜脈移植物內瘺的長期隨訪結果[J]. 中華醫學雜志, 2024, 104(32): 3032-3036.
24.	Yu H, Bao X, Li D, et al. Management of hemodialysis catheter-induced cavoatrial junction lesion by VBX stent-graft[J]. J Vasc Access, 2026, 28: 11297298261435742.
25.	Grima MJ, Vriens B, Holt PJ, et al. An arterioarterial prosthetic graft as an alternative option for haemodialysis access: a systematic review[J]. J Vasc Access, 2018, 19(1): 45-51.

1. 中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
2. Kundu S. Central venous disease in hemodialysis patients: prevalence, etiology and treatment[J]. J Vasc Access, 2010, 11(1): 1-7.
3. Agarwal AK. Central vein stenosis[J]. Am J Kidney Dis, 2013, 61(6): 1001-1015.
4. Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist’s perspective[J]. Semin Dial, 2007, 20(1): 53-62.
5. Schmidli J, Widmer MK, Basile C, et al. Editor’s choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2018, 55(6): 757-818.
6. Kukita K, Ohira S, Amano I, et al. 2011 update Japanese Society for Dialysis Therapy guidelines of vascular access construction and repair for chronic hemodialysis[J]. Ther Apher Dial, 2015, 19(Suppl 1): 1-39.
7. Nakamura T, Suemitsu K, Nakamura J. Superficialization of brachial artery as effective alternative vascular access[J]. J Vasc Surg, 2014, 59(5): 1385-1392.
8. Murakami M, Sakaguchi G, Mori N. Arteriovenous fistula combined with brachial artery superficialization is effective in patients with a high risk of maturation failure[J]. J Vasc Surg, 2017, 65(2): 452-458.
9. Weyde W, Kusztal M, Go??biowski T, et al. Superficialization of the radial artery--an alternative secondary vascular access[J]. J Vasc Access, 2012, 13(4): 504-507.
10. Ge W, Shi Y, Liu S, et al. Superficialization of dilated radial artery for vascular access: a case report[J]. J Vasc Access, 2023, 24(4): 818-820.
11. Salgado OJ, Terán NA, Rosales B, et al. Subcutaneous transposition of the superficial femoral artery for arterioarterial hemodialysis: technique and results[J]. Artif Organs, 2008, 32(12): 969-973.
12. Yasunaga C, Nakamoto M, Fukuda K, et al. Superficial repositioning of the artery for chronic hemodialysis: indications and prognosis[J]. Am J Kidney Dis, 1995, 26(4): 602-606.
13. Nayman J. An arterioarterial shunt for use in haemodialysis[J]. Lancet, 1964, 1(7329): 365.
14. Ali H, Elbadawy A, Saleh M. Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access[J]. J Vasc Surg, 2020, 72(1): 181-187.
15. Talaiezadeh AH, Haghighi KE. Arterio-arterial prosthetic duct (AAD) as a vascular access in hemodialysis[J]. J Vasc Access, 2004, 5(3): 113-115.
16. Bünger CM, Kr?ger J, Kock L, et al. Axillary-axillary interarterial chest loop conduit as an alternative for chronic hemodialysis access[J]. J Vasc Surg, 2005, 42(2): 290-295.
17. Khafagy T, Regal S, ElKassaby M, et al. Early results of brachial arterio-arterial prosthetic loop (AAPL) for hemodialysis[J]. Eur J Vasc Endovasc Surg, 2016, 51(6): 867-871.
18. Lei W, Ji J, Wang J, et al. Arterioarterial prosthetic loop as an alternative approach for hemodialysis access[J]. Medicine (Baltimore), 2015, 94(41): e1645.
19. Zanow J, Kruger U, Petzold M, et al. Arterioarterial prosthetic loop: a new approach for hemodialysis access[J]. J Vasc Surg, 2005, 41(6): 1007-1012.
20. Rahim AMAA, Bush A, Ahmed AAS, et al. Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study[J]. Pan Afr Med J, 2021, 40: 245.
21. 崔銳, 郝旭陽, 詹申, 等. 移植物動脈-動脈通路在血液透析中的應用效果[J]. 中華醫學雜志, 2024, 104(32): 3063-3066.
22. 劉思潔, 鮑雪東, 施婭雪, 等. 利用自體動靜脈內瘺創造血管條件建立前臂人工血管動靜脈內瘺 1 例[J]. 中國血管外科雜志(電子版), 2025, 17(3): 287-289, 291.
23. 米蘭化, 鮑雪東, 施婭雪, 等. 下肢動靜脈移植物內瘺的長期隨訪結果[J]. 中華醫學雜志, 2024, 104(32): 3032-3036.
24. Yu H, Bao X, Li D, et al. Management of hemodialysis catheter-induced cavoatrial junction lesion by VBX stent-graft[J]. J Vasc Access, 2026, 28: 11297298261435742.
25. Grima MJ, Vriens B, Holt PJ, et al. An arterioarterial prosthetic graft as an alternative option for haemodialysis access: a systematic review[J]. J Vasc Access, 2018, 19(1): 45-51.

West China Medical Journal

Efficacy of lower extremity arterio-arterial graft and literature review

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