Reversal of blood flow direction for the salvage of forearm straight and looped ePTFE-shunts.
Long venous anastomotic stenosis of a forearm haemodialysis graft necessitates extension of the venous limb. If the extension graft crosses the antecubital region, it will be subject to kinking, and re-occlusion may be the consequence. We report our experiences with a procedure proposed by Schulak combining reversal of blood flow of forearm looped grafts and extension of the venous limbs along the ulnar aspect of the elbow. Detailed information is given on how to modify the original method in order to treat patients with straight grafts, or with looped grafts and a "misplaced" venous extension. Ten patients were successfully treated with Schulak's procedure or its modification. No intra- or post-operative complications occurred. During follow-up (from 3 to 12 months), all grafts have remained patent.
Mickley
V
V
Department of Thoracic and Vascular Surgery, University of Ulm.
Storck
M
M
Abendroth
D
D
D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012086:Reoperation
D011138:Polytetrafluoroethylene