Abstract
We report 2 successful surgical cases of arteriovenous axillary crossover grafts (AVACG) for hemodialysis by using 4-mm to 6-mm polytetrafluoroethylene (PTFE) tapered grafts. Patient 1: A 91-year-old woman was admitted with vascular access failure (VAF), and a brachial-basilic arteriovenous fistula (BBAVF) was initially created. However, the BBAVF became occluded due to severe rigidity of an upper extremity. Both her upper and lower extremities were also rigid, making vascular access in the extremities difficult. However, AVACG using a 4-mm to 6-mm PTFE tapered graft was successfully performed to prevent heart failure or steal syndrome due to high flow VA, and the AVACG became effective without any hemodynamic compromise at postoperative day (POD) 14. She was discharged at POD 40 following recovery from aspiration pneumonia. Patient 2: An 84-year-old woman was admitted with VAF after twice receiving treatment of radiocephalic arteriovenous fistula. She had difficulty keeping both her upper and lower extremities straight. Surgical intervention of AVACG using a 4-mm to 6-mm PTFE tapered graft was performed successfully, but she died from worsening respiratory failure due to pneumonia. However, the AVACG remained patent just prior to death. From these results, AVACG with tapered graft may be an effective surgical method to maintain VA in elderly patients with rigid extremities.
