Preliminary experience with patch-enlarged brachial artery for hemodialysis access.

The patency of patch-enlarged (capsule-shaped) brachial arteries for long-term hemodialysis access was evaluated retrospectively. Twelve brachial arteries were patched with polytetrafluoroethylene (PTFE) grafts (standard wall thickness), making 1 x 2 cm aneurysms proximal to the elbow joints in 10 patients (six men with six patches, four women with six patches; patient age: 53 to 76 years, mean age +/- SD: 65.4 +/- 8.5 years) between September 2001 and April 2002. Ten patches were needled for each hemodialysis session as blood-drawing ports. The port's 1-year primary patency rate was 90%, 2-year patency was 70%, and 3-year patency was 70%. Two patches were needled in each hemodialysis session for dialyzed blood infusion access; both clotted within 1 year, with intact vessel continuity. Patch enlargement (capsule-shaped) of the brachial artery with a PTFE graft can be used as a long-term blood-drawing access in selected patients. This novel access may help patients with central vein stenosis or occlusion (which some patients had) and may help patients who have comorbid conditions such as chronic congestive heart failure or liver cirrhosis with ascites.