A Salvaging Procedure with Composite Graft Configuration in Poor Outflow Arterio-Venous Fistula for Hemodialysis: Report of Two Cases

ABSTRACT

Maturation failure after creation of autogenous arterio-venous fistula (AVF) is closely related to unrecognized stenosis or sclerosis of outflow veins. To address this problem, we chose to salvage a segment of venous conduit. A 51 year-old male patient underwent an AVF operation at the snuffbox. Postoperatively, fistula flow was not well developed on the upper forearm despite venous dilatation up to the dorsal radial branch of cephalic vein. After 3 weeks, a graft was inserted between the dilated cephalic vein and antecubital vein. The other patient was a 71 year-old man who underwent an AVF operation above the left wrist. Despite partial dilatation of veins near the anastomosis, flow was not well developed on the upper forearm. After 8 days, a graft was inserted between the dilated cephalic vein and antecubital vein. In summary, we interposed a segment of synthetic graft between dilated veins for primary maturation failure of autogenous AVF. This composite graft configuration may have advantage over total graft configuration, which should be confirmed by further study.