Conversion of a Scribner shunt to an arteriovenous fistula for chronic dialysis

Since July, 1972, we have converted 14 Scribner shunts, which we had used for the initiation of hemodialysis in 14 patients with end-stage renal disease, to arteriovenous fistulas in the same peripheral artery and vein of the shunts for maintenance chronic dialysis. The shunts were converted to fistulaes electively in three patients and because of malfunction in 11. We did not convert infected shunts. Dialysis was resumed within 24 to 72 hours of conversion to a fistula in all 14 patients. Thirteen patients were followed from 14 to 1,505 days with pump speeds of about 300 cc/minute. The fistulas continued to function without complication. One patient developed a small pseudoaneurysm, which required excision. The overall patency rate was 93%. The autogenous peripheral vessels of a patient on chronic hemodialysis are a limited resource. This conversion or recycling technique will give the patient a preferred vascular access for dialysis for prolonged periods.