Endovascular placement of the venous limb of a dialysis access graft using a Gore TAG introducer sheath in a patient with a difficult access.

Few situations are as vexing for vascular surgeons and their patients as the need for placement of permanent dialysis access when very few access sites remain viable. We recently encountered a patient who typifies this group. After venoplasty of the patient's right femoral and iliac veins, we placed a right superficial femoral artery to inferior vena cava 6-mm polytetrafluoroethylene graft. Under fluoroscopic guidance, we placed the venous limb of the graft directly into the inferior vena cava using a 24-French Gore thoracic aortic graft (TAG) introducer sheath. We secured the venous limb with a purse-string suture at the entrance site in the femoral vein. A standard end-to-side arterial anastomosis was performed. The access has worked without issue for over a year at this point.