UPPER EXTREMITY VASCULAR ACCESS FOR CONTINUOUS ARTERIOVENOUS HEMOFILTRATION AND DIALYSIS AFTER CARDIAC OPERATIONS

Background. There is increasing interest in the use of continuous arte riovenous hemofiltration/dialysis for treatment of profound renal fail ure after cardiovascular operations. Vascular access for this is usual ly accomplished by percutaneous cannulation of the femoral artery and vein, with the inherent risks of vascular trauma, patient immobilizati on, hemorrhage, or infectious complications. Methods. Fifteen (0.36%) of 4,166 patients receiving cardiovascular surgical procedures sustain ed postoperative renal failure requiring treatment with continuous art eriovenous hemofiltration/dialysis. Each patient had creation of acute arteriovenous forearm access using a modified Allen-Brown shunt. Shun ts were monitored continuously for hemorrhage, malfunction, infection, and thrombus, and were explanted when no longer required. Results. Si xteen shunts were implanted in 15 patients over the 41-month period. A ll shunts functioned satisfactorily, with the duration of implantation ranging from 1 to 64 days. There were no infectious or hemorrhagic co mplications. Conclusion. 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 beds ide, has a low complication rate, is available for immediate use, may be left in place indefinitely, does not interfere with patient mobiliz ation or ambulation, and is easily removed.