Loop-configured upper-arm hemodialysis graft for the "hostile" arm.

Abstract

As previously described by Brescia and colleagues in 1966, the totally autogenous arteriovenous (AV) fistula still remains the gold standard for longterm hemodialysis access. Even though there has been an increased emphasis on the use of AV fistulas, an AV fistula cannot be constructed in all hemodialysis patients, mainly because of poor venous anatomy. An AV bridge graft, usually made with expanded polytetrafluoroethylene (PTFE), continues to be a reasonable alternative form of hemodialysis access for most of these remaining hemodialysis patients. Our initial preference for an AV PTFE graft is usually a loop-configured forearm access, which is either anastomosed totally below the elbow or as a primary jump graft to the upper-arm basilic vein. For an upperarm PTFE hemodialysis access, our preference has been a straight-configured AV PTFE graft anastomosed from the lower upper-arm brachial artery just above the elbow to the upper brachial or axillary vein. We have a group of patients for whom an upper-arm loop-configured AV PTFE graft needed to be constructed (Fig. 1). With no identified series to reference, concerns about indications and longterm patency of these upper-arm loop AV PTFE grafts prompted us to review our most recent patient experience with this type of configured graft.