The reverse upper arm curved graft with ringed PTFE graft as an alternative vascular access procedure for hemodialysis.
OBJECTIVE
Prosthetic arteriovenous accesses are the last resort after efforts to place autogenous accesses are exhausted. During reimplantation of the graft, it is sometimes not convenient to dissect out the vessels to be grafted, especially around the venous anastomotic site and under local anesthesia.


METHODS
We describe a technique using the ringed PTFE graft for the construction of a reverse upper arm curved graft in 14 patients who had received upper arm grafts previously.


RESULTS
The mean operative time was 61+/-13 minutes, and the follow-up interval extended to 20 months. No infections, pseudoaneurysm formations, or steal syndrome occurred during the follow-up period. The primary patency rate was calculated by Kaplan-Meier analysis, and the primary patency from graft insertion to clotting in the reverse graft was 91% at 3 months, 83% at 6 months, 66% at 9 months, and 57% at 12 months.


CONCLUSIONS
These results suggest that using the reverse upper arm curved graft during the reimplantation procedure was an alternative prosthetic arteriovenous access with the advantage of less tissue dissection, shorter operation time, and favorable patency rate.
Kao
C-L
CL
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC. sa11421@adm.cgmh.org.tw
Chang
J-P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects / Q000592:standards; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000295:instrumentation*; D012092:Replantation / Q000295:instrumentation*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D011138:Polytetrafluoroethylene