Indications and clinical experiences with central arteriovenous shunts for chronic hemodialysis

Central av-shunts are indicated in patients who underwent multiple operations for dialysis access on the extremities or became periphero-vascular inoperable due to local infections. Between 1982 and 9/1994 116 patients had been operated. 71 patients obtained a subclavio-subclavial shunt, 13 patients a subclavio-jugular shunt and 32 patients a femorofemoral shunt. As acute postoperative complication we found in seven patients an early thrombosis 2 to 6 days after operation, which could be thrombectomized unproblematically. Two patients after subclavio-subclavial shunt operation and 3 patients after femoro-femoral shunt acquired an infection of the prosthesis, which made the removal of the prosthesis necessary. In one patient with carcinoma a ligation of the av-shunt was done because of an extreme venous congestion due to a benign stenosis of the iliacal vein. Late thromboses were found in 15 patients. These occlusions were thrombectomized after anticoagulation or in case of complete occlusion of the collecting vein were treated by an extension of the prosthesis to another central vein. 35 patients died 15 days to 9 years (mean 6.4 years) after operation. It can be concluded that central av-shunts show a stable long-term function.