A simplified technique for the tunneling of extra-anatomic polytetrafluoroethylene grafts

A technique using the trocars from disposable thoracostomy sets as a tunneling instrument in vascular operations is described. A number of preselected and hand shaped trocars, with a single hole drilled in the puncture tip end, are kept sterile on the vascular surgical supply cart and can be used to construct perfectly calibrated tunnels for cross-subclavian and axillo-axillary graft procedures as well as other extra-anatomic graft procedures. They are especially useful in the construction of the tunnels for the loop forearm Gore-Tex arteriovenous fistula for angioaccess which can be used almost immediately. These otherwise disposable instruments can be resterilized and are, hence, quite cost-effective as well as convenient and easy to use.