Salvage of upper arm access grafts by extension to the infraclavicular axillary vein.

A technique has been described to salvage upper arm graft fistulas using expanded polytetrafluoroethylene grafts by subcutaneous extension to the infraclavicular axillary vein. The axillary vein is exposed through an infraclavicular incision near the lateral end of the clavicle by splitting the pectoralis major muscle and by dividing or retracting the pectoralis minor muscle medially. A new segment of polytetrafluoroethylene graft is anastomosed to the axillary vein, and then to the old graft segment. This technique was employed in six patients over a 12 month period, with a 24 month graft patency rate of 84 percent. The advantage over a new access graft is immediate hemodialysis through a puncture of the preserved arterial limb of the polytetrafluoroethylene graft.