الفهرس 
Introduction and Aim of workOnly 14 pages are availabe for public view
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Abstract
Vascular access failure causes substantial morbidity in patients with end-stage renal disease who require long-term hemodialysis. As standard vascular access, an arteriovenous (AV) fistula created with a superficial vein or a prosthetic AV access with a suitable deep vein are used.
Still, in some patients, veins can be exhausted owing to multiple long-term indwelling central vein catheters (CVC), transvenous pacemakers, or previously failed AV vascular access attempts.
Stenosis and occlusion of central veins can be treated surgically or by angioplasty to establish sufficient outflow required for AV access. Central subclavian vein obstruction can be reconstructed by different surgical techniques with good results. However, these procedures need a suitable jugular vein or undisturbed contralateral venous outflow.
Endovascular interventions for the treatment of central venous obstruction show excellent initial success, but primary patency rates for 1 year are < 50%, restenosis rates are high, and long-term results are uncertain.
Several uncommon procedures for maintenance of AV grafts at central venous obstruction have been published. However, some of these approaches appear inadequate for the creation of vascular access.
Symptomatic ischemia distal to an AV fistula occurs in around 4% of patients. In a very few patients, the arterial status does not allow the construction of an AV graft, even if the graft is fed by a central artery.
These patients represent a group with complex vascular access problems that preclude the creation of a conventional vascular access. Tunneled central venous catheters do not represent an acceptable long-term alternative.
An arterioarterial prosthetic loop (AAPL) was developed for such patients. The AAPL is a polytetrafluoroethylene (PTFE) graft loop interposed in the continuity of the axillary or femoral artery that can be used as the vascular access for hemodialysis.