2020 Volume 53 Issue 6 Pages 305-311
Arteriovenous loop grafts (AVLGs) on the forearm make excellent vascular access points because they have a wide puncture range and make it easy to perform daily puncture procedures and achieve hemostasis. However, their long-term use causes hardening of the loop graft itself, intimal thickening, and pseudoaneurysm formation caused by frequent puncturing, which often leads to thrombosis. It becomes increasingly difficult to treat these problems during vascular access intervention therapy (VAIVT). In 13 patients with AVLGs on their forearms that were used for VAIVT, we performed surgery to remove the aging loop graft, create a skin flap, and transfer a new graft to the original loop graft site. Only half of each loop graft was replaced, and daily dialysis was continued using the remaining part of the loop that had not been replaced. Postoperatively, the patients only experienced mild wound pain and slight swelling of the forearm. After that, VAIVT was performed in all cases, as appropriate, and second operations on the remaining parts of the loop grafts were performed in 6 cases. Dialysis via the forearm loop graft was able to continue as before in all cases. No temporary hemodialysis catheters were required during the surgical procedure. Creating a skin flap has the advantage that the puncture range of the graft is not limited in the future.
