Improved patency of prosthetic arteriovenous grafts with an acute anastomotic angle and flow diffuser

Albert G. Hakaim, Matthew N. Nalbandian, Jennifer K. Heller, Arun C. Chowla, W. Andrew Oldenburg

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: Conventional end-to-side anastomosis to establish venous outflow for prosthetic arteriovenous grafts often requires operative patch angioplasty within 1 year because of venous stenosis. Rather than conventional venous anastomosis, a modified end-to-side anastomosis at a 15-degree angle with a flow diffuser was constructed. Such diffusers allow decreased flow velocity and increased pressure, inhibiting boundary layer separation. Methods: Ten brachial artery to axillary vein 6 mm straight se-polytetrafluoroethylene prosthetic arteriovenous grafts were created with this technique. Patients included 6 men and 4 women (mean age, 66.4 years; range, 54-80 years), all with renal failure and a history of diabetes. The degree of stenosis at the venous anastomosis was determined with duplex scanning at intervals of 6 months. Analysis of survival and cumulative primary patency estimates were determined with the Kaplan-Meier method. Results: Primary cumulative patency estimate of 100% for the modified group at 18 and 24 months was significantly greater than that for age-matched historic control fistulas with the conventional end-to-side anastomosis (n = 20): 18 months, 32%; 24 months, 32% (P < .05). Although venous stenosis could not be quantitated for thrombosed conventional fistulas, modified anastomoses had minimal stenosis at 24 months: mean area reduction, 30% (range, 20%-45%). Conclusion: Incorporation of a flow diffuser and a 15-degree anastomotic angle significantly increases patency of prosthetic brachial artery to axillary vein grafts.

Original languageEnglish (US)
Pages (from-to)1032-1035
Number of pages4
JournalJournal of vascular surgery
Issue number5
StatePublished - May 1 2003

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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