Anterior Chest Wall Axillary Artery to Contralateral Axillary Vein Graft for Vascular Access in Hemodialysis

Patients with end-stage renal failure and peripheral vascular disease pose a difficult management problem in establishing long-term angioaccess for hemodialysis. In 4 patients with access problems, we created axillary artery to contralateral axillary vein Goretex grafts. The grafts were cannulated regularly for periods ranging from 29 to 66 months without difficulty. There was one episode of thrombosis and one of congestive heart failure. The mean venous pressure was 120 mm Hg with a mean arterial flow of 220 ml/min. This type of vascular access can provide adequate blood flow in difficult patients and maintain efficient dialysis. It should be a useful addition to the armamentarium of the vascular surgeon.