A new vascular access procedure for immediate as well as chronic hemodialysis.

A new vascular access procedure consists of attaching an arteriovenous shunt to a subcutaneous arteriovenous fistula. The procedure was designed for patients who need immediate as well as long term hemodialysis and in whom the Brescia-Cimino type of fistula could not be done. Secondary objectives for this new procedure were a prolonged patency interval and a lower complication rate of arteriovenous fistulas. Six patients underwent this procedure and were observed from two to five months. Five shunts remained patent for a minimum of two weeks. Five patients have presently functioning fistulas, and in three of these, both shunts and fistulas remain patent. Two of the presently functioning shunts required declotting. Two shunts were removed when neither declotting nor revision was possible, and one shunt was removed because of infection. One fistula was lost due to a technical error, and two of the five presently functioning fistulas have required declotting. We believe clotting was due chiefly to the fact that patients selected for this procedure were from the group who had multiple previous clotting episodes and vascular access procedures. It remains to be seen whether or not more careful patient selection will accomplish the secondary objectives.