Abstract
It is widely accepted that a native arteriovenous fistula (AVF) and an arteriovenous graft (AVG) in the upper extremity are the first and second choices for chronic hemodialysis access, respectively. However, it is increasingly common to encounter patients whose options for vascular access have been exhausted and in some patients the creation of vascular access is contraindicated. For 4 such patients we created arterio-arterial prosthetic loops (AAPL) for hemodialysis.
Case 1: An 80-year-old woman had severe chronic cardiac failure due to mitral regurgitation. Case 2: A 50-year-old man had critical steal ischemic syndrome in the right upper extremity. Both cases 3 and 4 had inadequate veins for the creation of vascular access and it was impossible to place indwelling catheters.
We successfully applied an AAPL in all patients using a thoratec vascular graft under local anesthesia. The AAPL was a very efficient method to establish vascular access for hemodialysis in patients in whom conventional vascular access could not be established.
