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Ann Thorac Surg 1995;60:1072-1075
© 1995 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Upper Extremity Vascular Access for Continuous Arteriovenous Hemofiltration and Dialysis After Cardiac Operations

Jerome B. Riebman, MD, Glenn W. Laub, MD, Albert H. Olivencia-Yurvati, DO, Lynn B. McGrath, MD

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Deborah Heart and Lung Center, Browns Mills; and the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey

Accepted for publication May 15, 1995.

Background. There is increasing interest in the use of continuous arteriovenous hemofiltration/dialysis for treatment of profound renal failure after cardiovascular operations. Vascular access for this is usually accomplished by percutaneous cannulation of the femoral artery and vein, with the inherent risks of vascular trauma, patient immobilization, hemorrhage, or infectious complications.

Methods. Fifteen (0.36%) of 4,166 patients receiving cardiovascular surgical procedures sustained postoperative renal failure requiring treatment with continuous arteriovenous hemofiltration/dialysis. Each patient had creation of acute arteriovenous forearm access using a modified Allen-Brown shunt. Shunts were monitored continuously for hemorrhage, malfunction, infection, and thrombus, and were explanted when no longer required.

Results. Sixteen shunts were implanted in 15 patients over the 41-month period. All shunts functioned satisfactorily, with the duration of implantation ranging from 1 to 64 days. There were no infectious or hemorrhagic complications.

Conclusions. The acute creation of a simple forearm shunt for postoperative continuous arteriovenous hemofiltration/dialysis is preferred over femoral arterial and venous cannulation because it can be constructed rapidly and easily in the operating room or at the bedside, has a low complication rate, is available for immediate use, may be left in place indefinitely, does not interfere with patient mobilization or ambulation, and is easily removed.






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