The reverse upper arm curved graft with ringed PTFE graft as an alternative vascular access procedure for hemodialysis.

Aim. Prosthetic arteriovenous accesses are the last resort after efforts to place autogenous accesses are exhausted. During reimplantation of the graft, it is sometimes not convenient to dissect out the vessels to be grafted, especially around the venous anastomotic site and under local anesthesia. Methods. We describe a technique using the ringed PTFE graft for the construction of a reverse upper arm curved graft in 14 patients who had received upper arm grafts previously. Results. The mean operative time was 61′13 minutes, and the follow-up interval extended to 20 months. No infections, pseudoaneurysm formations, or steal syndrome occurred during the follow-up period. The primary patency rate was calculated by Kaplan-Meier analysis, and the primary patency from graft insertion to clotting in the reverse graft was 91% at 3 months, 83% at 6 months, 66% at 9 months, and 57% at 12 months. Conclusion. These results suggest that using the reverse upper arm curved graft during the reimplantation procedure was an alternative prosthetic arteriovenous access with the advantage of less tissue dissection, shorter operation time, and favorable patency rate.