Deltoid Loop Hybrid Bypass for Complex Dialysis Access

We sought to demonstrate the technical aspects of atypical arteriovenous graft (AVG) creation for hemodialysis in a patient with multiple previous failed attempts at vascular access. A 38-year-old female diabetes and dialysis access was referred our center. Preoperative duplex ultrasound venography showed patent central venous outflow, no sufficient superficial conduit, poor arterial inflow high risk steal syndrome. With under general anesthesia, conventional infraclavicular approach performed left axillary artery. Percutaneous puncture internal jugular vein followed by superior vena cava catheterization an 0.035-in. hydrophilic wire. 4- 7-mm polytetrafluoroethylene (PTFE) (Flixene graft; Getinge, Gothenburg, Sweden) subcutaneously tunneled looped (Fig) over deltoid muscle, wire fed retrograde through exiting from proximal 4 mm end graft. 7 × 150-mm self-expandable Viabahn endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) then introduced deployed distal graft, bridging PTFE brachiocephalic vein, without need suturing. The entire length postdilated balloon ensure full expansion. Finally, anastomosis anastomosed side artery running Prolene suture. postoperative course uneventful, cannulated successfully two needles 2 weeks after surgery. At 6-month follow-up, AVG remained patent, or outflow stenosis. have presented loop technique that does not require suturing side. latter part can be applicable different locations. This could useful selected patients.