Autogenous Saphenous Vein Grafts as Vascular Access for Hemodialysis

Abstract

Procedures for obtaining access to the circulation for hemodialysis should have two fundamental aims. These are long-term patency and freedom from complications. These aims can best be achieved by the use of an internal fistula and the use of autogenous material in its construction. Implicit in this strategy is the requirement to anticipate the need for hemodialysis and to preserve the veins of the upper extremities. There is general agreement that the radial artery to cephalic vein arteriovenous fistula described by Brescia and his colleagues [1] is the best method of obtaining access to the circulation. There is, however, a significant group of patients whose arteries or veins are unsuitable for the construction of such a fistula. It was for these patients that the autogenous saphenous vein graft arteriovenous fistula was introduced by May et al. [2]. There is also a group of patients who have been on dialysis for many years and a further group of patients who are returning to dialysis as renal grafts fail. Patients in these two categories are frequently devoid of native veins suitable for an internal fistula in the upper extremity.