الفهرس 
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Abstract
The aim of this study was to Study the short-term results of the axillary arterioarterial prosthetic loop grafts as an alternative approach for hemodialysis access.
Twenty patients were included in this study (13 males and 7 females) with mean age was 50.2 y. 10 patients were hypertensive, seven were diabetic, 5 had IHD, 5 had cerebrovascular stroke and 4 were hepatic. 19 patients had history of 2 or more native AVF, 9 patients had an AV graft and 13 patients had a jugular or subclavianpermicath as a previous permanent access.
The creation of AAPL was indicated in central venous occlusion (CVO) in 15 patients (75%), while multi-access failure with no possibility to create native AVF (either at the wrist or the elbow or an upper limb AV graft was the indication in 3 patients (15%), steal syndrome in one patient (5%) and heart failure in one patient (5%) as the AAPL graft has the advantage of maintaining normal arterial flow without the possibility of steal or cardiac overload. Primary and secondary patency rates at 6 months were 70% and 90% respectively.
Upper limb edema was the most common complication, which was managed conservatively and resolved after few weeks. Access thrombosis occurred in 4 patients with mild hand ischemia, thrombectomy was done with disappearance of hand ischemia and salvage of the graft in 3 patients, while in the fourth patient the graft was severely lacerated so excision of the graft was performed. Severe infection was encountered in one patient with secondary hemorrhage which necessitated graft excision and ligation of the axillary artery with compensated upper limb.
One patient developed pseudoaneurysm at the puncture site which was treated by excision of the affected graft segment and its repair with interposition graft. One patient developed seroma postoperatively at the infraclavicular incision, it was surgically evacuated with no affection of the graft.