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Joseph L. Giacchino, MD; W. Peter Geis, MD, FACS; John M. Buckingham, MB, BS; Leonard L. Vertuno, MD; Vinod K. Bansal, MD

Arch Surg. 1979;114(4):403-409.

Abstract
• Effective approaches to unique problems of vascular access in renal failure have evolved from a five-year experience with 840 angioaccess procedures. Standard techniques plus innovations have required only 0.62 operations per year per patient with an average access life of 1.6 years. Classical forearm external arteriovenous (AV) cannulas and internal AV fistulas provided vascular access in 392 patients, while 61 required more complex procedures due to failure of primary cannulas and fistulas, inherently small forearm vessels, and iatrogenic vessel loss. Secondary techniques include reverse fistula, vascular graft AV fistulas using expanded polytetrafluoroethylene (E-PTFE), and arterioarterial (AA) jump graft. Presently, the new renal failure patient receives a forearm radiocephalic AV fistula; the cannula is restricted to emergency or short-term hemodialysis and may later be converted to a subcutaneous fistula. The reverse fistula is attempted before using E-PTFE grafts. Upper extremity AV and AA loops can then be constructed de novo or from the reverse fistula.

(Arch Surg 114:403-409, 1979)

Author Affiliations
From the Transplantation Section, Departments of Surgery (Drs Geis, Giacchino, and Buckingham) and Medicine (Drs Vertuno and Bansal), Loyola University Stritch School of Medicine, Maywood, Ill; and Hines Veterans Administration Hospital, Hines, Ill.

Footnotes
Accepted for publication Dec 18, 1978.

Read before the 86th annual meeting of the Western Surgical Association, Nov 13, 1978, Scottsdale, Ariz.

Reprint requests to Department of Surgery, Loyola University Hospital, 2160 S First Ave, Maywood, IL 60153 (Dr Geis).

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