Novel hybrid brachio-axillary arterio-venous synthetic-graft-to-endograft procedure for primary haemodialysis access construction

Effective vascular access may be particularly challenging to construct and to maintain, particularly in patients on long standing dialysis dependence, compromised by multiple prior access failures, vascular conduit degradation and chronic access-related comorbidities. Presented herein is a case involving the primary construction of a novel hybrid brachio-axillary arteriovenous graft (AVG), performed de novo using a synthetic graft anastomosed distally to the brachial artery and bridged proximally with a self-expanding stent-graft deployed under ultrasonic and c-arm guidance into the axillary and subclavian veins. This procedure was conducted in a 41-year-old male with multiple prior access failures, and resulted in an effective and sustainable (>6/12) haemodialysis access.