The axillary artery-popliteal vein extended polytetrafluoroethylene graft: a new technique for the complicated dialysis access patient

It is essential to increase the level of awareness for the need to preserve the integrity of the venous system in the dialysis patient. Central venous stenosis is a major problem for this population, effectively excluding an affected individual from the safest and most efficacious form of vascular access—a native upper limb fistula. Amongst end-stage renal failure (ESRF) patients central venous stenosis is most common in those who have had subclavian catheterization with an observed incidence of over 40% [1]. Current treatment of central stenosis is by angioplasty and stenting [for early (<3 months) recurrence and elastic lesions]. However, there is an initial failure rate of 30% and recurrence within a year is the norm [2]. Managing the access of such patients is often made more complex by the presence of significant peripheral vascular disease in the lower limbs. This precludes a lower limb fistula based on the femoral vessels because of the significant risk of a ‘steal syndrome’ or frank gangrene.