Retroperitoneal approach for lower extremity arteriovenous graft as long-term vascular access in a complex case.

A 76-year-old woman with stage 5 chronic kidney disease requiring hemodialysis had a long history of hypertension and diabetes. Her venous access was exhausted because of several previous access procedures including autogenous arteriovenous fistula operations and central venous catheter placements. After evaluating the function of her vessels when she was transferred to Renji hospital, we created an arteriovenous graft via a retroperitoneal approach in her right lower extremity. We inserted two grafts into her right thigh, a straight external ring and a loop graft. Twenty days after operation the patient's new access was successfully used in the treatment of hemodialysis. She has been followed up to now without occurrence of any graft-related events.