REVERSAL OF BLOOD-FLOW DIRECTION FOR THE SALVAGE OF FOREARM STRAIGHT AND LOOPED EPTFE-SHUNTS

Long venous anastomotic stenosis of a forearm haemodialysis graft nece ssitates extension of the venous limb. If the extension graft crosses the antecubital region, it will be subject to kinking, and re-occlusio n may be the consequence. We report our experiences with a procedure p roposed by Schulak combining reversal of blood flow of forearm looped grafts and extension of the venous limbs along the ulnar aspect of the elbow. Detailed information is given on how to modify the original me thod in order to treat patients with straight grafts, or with looped g rafts and a ''misplaced'' venous extension. Ten patients were successf ully treated with Schulak's procedure or its modification. No intra- o r post-operative complications occurred. During follow-up (from 3 to 1 2 months), all grafts have remained patent.