A systematic review of brachial artery ligation as a safe and feasible option in the management of arteriovenous dialysis access infection.

Abstract

OBJECTIVE\nCreation of good long-term arteriovenous access is essential in patients requiring hemodialysis for end stage renal failure. However, arteriovenous grafts or fistulae can be complicated by infection which may require emergency surgery. For infections that involve the brachial artery anastomosis, or if total graft explantation is indicated, brachial artery repair or reconstruction is often required. An alternative management strategy would be brachial artery ligation (BAL). We performed a systematic review to evaluate the outcomes of BAL that has been performed for infected arteriovenous grafts or fistulae.\n\n\nMETHODS\nA thorough literature search was conducted using various electronic databases. We included articles that reported outcomes of BAL performed for infected arteriovenous grafts or fistulae. The primary outcome was the incidence of upper limb ischemia after BAL. Secondary outcomes were the need for urgent revascularization, upper limb amputation and postoperative neurological deficit after BAL.\n\n\nRESULTS\nA total of five studies with a total of 125 patients were included in our systematic review. BAL was performed for infected arteriovenous grafts or fistulae for all studies. Follow-up period ranged from one to 27 months. The incidence of upper limb ischemia after BAL low. Only a single study reported three patients that developed upper limb ischemia. Two patients required urgent revascularization and one patient required forearm amputation after proximal ligation. All studies reported clearance of infection with no recurrence.results CONCLUSIONS: : Distal BAL may be performed safely for patients with an infected arteriovenous fistulae or grafts with low risk of upper limb ischemia, postoperative neurological deficit and recurrent infection.\n\n\nCONCLUSION