• A Prospective Study for Evaluation of Efficacy of Ligation of the Intersphincteric Fistula Tract (Lift) for Treatment of Patints with Fistula-In-Ano
    Mustafa Biomy and Eslam M. Ibrahim
  • A Comparison of Laparoscopic and Open Repair of Perforated Duodenal Ulcer Using Omental Patch: A Prospective Randomized Controlled Trial
    Tamer Alsaied Alnaimy , Tamer Rushdy Elalfy and Mohammed A.Elkilany
  • The Value of Preoperative Ultrasound In Predicting Technical Difficulties During Laparoscopic Cholecystectomy
    Ahmed Mahmoud Hussein1 M.D.; Ahmed Abd Alaziz Mohammad1 M.D.; Ahmed Mohammed Ahmed Nasser2 M.Sc.
  • Iliofemoral Venous Stenting for Patients with Chronic Post-thrombotic Venous Occlusive Disease
    Sherif Essam Eldin Tawfik, MD; Abdelrahman Mohamed Salem, MD
  • Peroneal Artery Angioplasty As a Single Runoff Vessel for Foot Revascularization in Patients with Critical Limb Ischemia
    Abdelrahman Mohammed, MD, Ahmed Kamal Gabr, MD, Sherif Essam Eldin Tawfik, MD
  • Fat Harvesting from the Excised Dermolipectomy Flaps for Fat Augmentation in Various Individuals
    Ashraf Elsebaie MD, Ahmed Abdelsalam Hafiz MD, Ahmed Maher MD, Rasha Abdelkader MD
  • Evelauation of the use of Gastrisailtm Gastric Positioning Device during Laparoscopic Sleeve Gastrectomy, Early Experince
    Ahmed M.S.M Marzouk, Haitham S. Omar
  • Feasibility of Round Block Mammoplasty As a Single Technique For Different Quadrants T1,T2 Malignant Breast Lesions. Fayoum University Hospital experience. A study of 25 patients.
    Hany F. Habashy
  • Laparoscopic Cholecystectomy following ERCP in One Day: A Retrospective Study
    Maged Rihan, MD, MRCS
  • Sleeve Gastrectomy with Hiatus Hernia Repair in 25 Egyptian Morbid Obese : Short Term Results
    Karim Sabry (MD, MRCS) , Wael A Jumuah (MD) ,Yasser El Ghamrini (MD)
  • Polypropylene Suture Fixation versus Fibrin Glue in Lichtenstein Inguinal Hernia Repair: A Prospective Randomized Study
    Ahmed Shoka, MD, MRCS, Fady Makram, MD, FACS, Mohamed Matar, MD, FACS.
  • Effect of Two Bariatric Procedures on Macro- and Micronutrient Levels Inspite of Multivitamin Supplementation
    Mohammed Matar,1 MD, FACS, Ahmed Shoka,1 MD, MRCS, Heba Nader,2 MD
  • Complicated Acute Cholecystitis; Protocol of Management
    Mokhtar Abd Elrahman Bahbah, MD; Ehab M Oraby, MD.
  • Motor Bike Accident is a Main Cause of Maxillofacial Fractures Presenting to Cairo University Hospitals: A Retrospective Study
    Youssif Khachaba, Waleed Reda, Ahmed Abd El Salam, Ahmed Samy Saad Hussein, Nadeen Mohamed El Essawy, Ashraf El Sebaie
  • Early Results of Arterioarterial Prosthetic Loop As a Bail Out Procedure in End Stage Renal Disease Patients With Multi-Access Failure
    Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
  • The Role of Carbon Dioxide As a Safe Contrast Agent in Endovascular Treatment of Chronic Lower Limb Ischemia in Patients with Renal Impairment or Iodinated Contrast Allergy
    Mahmoud Hamda MS, Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
  • Plastibell Versus Bone Cutting Techniques in Neonatal and Infantile Circumcision: A Retrospective Study and Review of Outcomes
    Ahmed M.S.M. Marzouk
  • Modalities of Pre-Operative Marking Techniques for Breast Reduction & Mastopexy
    1Waleed AlBadry, MSc, MRCS;1Raafat Gohar, MD; 1Ashraf El-Sebaie; 2Mohamed Salah, MD;1Mohamed Ashraf El Meleigy, MD
  • Early Results of Arterioarterial Prosthetic Loop As a Bail Out Procedure in End Stage Renal Disease Patients With Multi-Access Failure

    Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
    Department of Vascular Surgery – Alexandria University

    Background: Arteriovenous fistula (AVF) is the standard access for hemodialysis in end-stage renal disease (ESRD) patients on maintenance hemodialysis. Because of the higher rate of morbidity and mortality associated with central venous catheter (CVC), it should be used after exhaustion of all AVF options. Sometimes, insertion of CVC is very difficult or impossible even with radiological guidance due to central venous obstruction. Therefore, a category of patients with multi-access failure and central venous obstruction requires a reliable alternative access. Since arterio-arterial prosthetic loop (AAPL) was introduced as an access for hemodialysis with encouraging results, in the present study we studied the use of axillary-axillary AAPL for patients with multi-access failure and unsuitable for conventional vascular access. Aim of the work: Evaluation of the early results of axillary arterio-arterial synthetic loop as a vascular access for hemodialysis in ESRD patients with multi-access failure. Patients and methods: Twenty ESRD adult patients on maintenance hemodialysis with multi-access failure and unsuitable for conventional vascular access underwent Axillary arterio-arterial prosthetic loop procedure for hemodialysis. All patients were assessed preoperatively by duplex ultrasonography for the targeted upper limb. Polytetrafluroethylene (PTFE) graft was interpositioned in the end to end manner to the ends of the axillary artery after exposure of the artery through infraclavicular incision and creation of a subcutaneously looped tunnel on the chest wall. All patients received acetylsalisyslic acid indefinitely after the operation and puncture of the graft was allowed after 2 weeks. All patients had regular follow up visits for 6 months to assess the AAPL as regards: wound care, records from dialysis unit and exclude complications. Results: The indications for creation of AAPL included multi-access failure with no possibility to create native AVF or AVG in 17 patients (85%), while steal syndrome was the indication in 2 patients (10%) and heart failure in 1 patient (5%). The mean operative time was 120 minutes (ranging from 90 to 140 minutes). The median length of hospital stay after the procedure was 4 days (ranging from 2 to 5 days) and the perioperative mortality rate at 30 days was 5 %. The median access flow at rest was 200 ml/min (150 – 300 ml/min) at 1 month postoperatively, with no significant difference at 3 and 6 months. Primary and secondary patency rates at 6 months were 80% and 90% respectively. Access thrombosis occurred in 3 patients with mild hand ischemia and the graft was salvaged 2 patients, while in the third patient the graft was severely lacerated and was ligated. Severe infection was encountered in one patient with secondary hemorrhage which necessitated graft excision and ligation of the axillary artery with compensated upper limb. Conclusion: Axillary arterio-arterial prosthetic loop can be considered as an alternative procedure for hemodialysis in ESRD patients with multi-access failure and occlusion of central veins. Key words: vascular access – arterioarterial prosthetic loop – hemodialysis.