Abstract
The incidence of renal failure in Saudi Arabia is increasing. Consequently, the number of required vascular access creation is increasing as well. The creation of multiple vascular accesses after thrombosis and the occlusion of the primary access occur frequently; however, the creation of a new access in the presence of central venous occlusion or arterial insufficiency creates a dilemma. Therefore, the creation of a secondary access may become necessary. The present report demonstrated two patients with multiple failed accesses and occluded subclavian vein at one side, and the unsuitable arteries for access on the other side. Both were treated successfully, the first with an axillary-axillary graft using simple PTFE, and the second with three-layer Flexin PTFE grafts. For three years now, both grafts have been functioning effectively for hemodialysis in both patients with no major complications. Axillary artery to axillary vein PTFE bridge graft is an excellent and durable secondary access strategy when primary access at upper limb is not feasible.