title: A novel technique designed to minimize the morbidity of failure of arteriovenous access in hemodialysis patients.
abstract: The failure of dialysis access grafts leads to significant morbidity rates in patients with end-stage renal disease. We describe a novel technique for the insertion of new polytetrafluoroethylene graft segments designed to reduce this morbidity rate. Patients found to have significant intragraft deterioration at thrombectomy undergo insertion of a new nonanastamosed graft parallel to the existing graft. At the next failure of the existing graft, the nonanastamosed segment is anastamosed and used immediately for dialysis, obviating the need for a temporary catheter. Thirty patients have undergone this technique, and 89% of those who returned to surgery have had successful anastamosis of their new segments. Two patients were found to have inadequate incorporation of their new segments into the subcutaneous tissue, and one became frankly infected.
authors.affiliation: Department of Surgery, Transplant Division, Tufts University School of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Benedetto
authors.forename: Robert L
authors.initials: RL
authors.lastname: Madden
authors.forename: Alexander
authors.initials: A
authors.lastname: Kurbanov
authors.forename: George S
authors.initials: GS
authors.lastname: Lipkowitz
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D001132:Arm / Q000098:blood supply / Q000601:surgery; D001158:Arteries / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000009:adverse effects*; D014680:Veins / Q000601:surgery