A new method of creating an arteriovenous graft access

Since the initial description of the radial arteriovenous (AV) shunt, hemodialysis has played a primary role in the survival of patients with chronic renal failure. However, it is not unusual to be confronted with patients on chronic hemodialysis who have exhausted all superficial venous access sites. We describe a technique using the deep veins of the arms the outflow system during AV graft construction. By anastomosing the venous limb of the graft to the larger of the two brachial veins, we have been able to give patients AV access when the superficial veins have been exhausted. We have performed this technique with good success in 12 patients. Further experience and longer follow-up are needed.