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Kidney Week

Abstract: FR-PO578

Successful Insertion and Use of Arteriovenous Graft (AVG) After Left Ventricular Assist Device (LVAD) Implantation

Session Information

Category: Trainee Case Report

  • 704 Dialysis: Vascular Access

Authors

  • Toma, Katherine, Columbia University Medical Center, New York, New York, United States
  • Stevens, Jacob, Columbia University Medical Center, New York, New York, United States
  • Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States
  • Husain, Syed Ali, Columbia University Medical Center, New York, New York, United States
Introduction

A subset of patients requires long-term renal replacement therapy (RRT) after LVAD implantation. The success of using AVG for RRT access in these patients has not been established.

Case Description

[Fig1]

Case A: A 68-year-old man developed acute kidney injury (AKI) requiring RRT 2 days after LVAD implantation. He remained RRT dependent. A brachiobasilic AVG was placed 55 days after LVAD implantation and successfully used 28 days later. Subsequent course was notable for S. bovis bacteremia complicated by infected AVG pseudoaneurysm requiring AVG excision. A second brachiobasilic AVG was placed and functioned well, requiring a thrombectomy 98 days after placement.

Case B: A 67-year-old man developed septic shock with AKI 18 months after LVAD implantation. He remained RRT dependent and brachiobasilic AVG was placed 584 days after LVAD implantation. Balloon angioplasty of the AVG was required for stenosis at the arterial anastomosis, and AVG was successfully used 32 days after placement. He required no subsequent vascular access procedures and had no access or bloodstream infections.

Case C: A 71-year-old man with stage 3b CKD developed AKI requiring RRT 4 days after LVAD implantation. He remained RRT dependent and brachiobasilic AVG was placed 107 days after LVAD implantation. Failed first cannulation attempt led to hematoma requiring evacuation and AVG revision. AVG was successfully used 40 days after placement. He later developed polymicrobial bacteremia from a driveline infection, and AVG was excised due to concern for seeding. A second brachiobasilic AVG was placed and functioned well, requiring a thrombectomy 147 days after placement.

Discussion

AVG can be successfully used for long-term RRT access in LVAD patients. Infection and thrombosis rates need further study in larger cohorts. Outcomes between AVG, AV fistula, and dialysis catheters should be evaluated.

Figure 1.