Many forearm loop grafts have multiple outflow interventions before failure. These angioplasties and outflow stents create inflammation around the vein just above the antecubital area. This inflammation makes arterial exposure difficult for a standard upper arm graft configuration. Accordingly, surgeons may avoid this area by performing an upper arm loop graft, which originates and terminates in one high arm incision. Upper arm loop grafts are also used for high bifurcation of the radial and ulnar arteries and when prior access grafts make other configurations difficult. Surgeons appear to place these upper arm loops routed with one limb running subcutaneously parallel to the brachial artery, placing half of the loop in an awkward position for cannulation.
Courtesy Dr. David Showalter
A more lateral configuration, routed over the bicep, makes access much more palatable for the dialysis technicians and more comfortable for the patient. This picture is such a graft at 7 days postop.
Dr. Showalter is clinical assistant professor of surgery, Florida State University Medical School, Tallahassee, and attending vascular surgeon, Sarasota Vascular Specialists.
