Salvage of a Failing Dialysis Graft by Percutaneous Creation of a Jump Bypass Graft

摘要

The article by Kuo et al (1) in the August issue of JVIR describes a clever and interesting technique for construction of a percutaneous bridge stent-graft for salvage of a dysfunctional hemodialysis graft. They are to be commended for their imagination and technical prowess. However, I have several major concerns with this article and the messages that it sends.First, the authors' opening statement that "arteriovenous grafts are a principal mainstay of long-term dialysis access" is (or should be) false. In 2007, most of the world and even much of the United States nephrology community recognize that the native arteriovenous fistula is the preferred form of vascular access. Through the widely promoted "Fistula First" program (2) there has been a concerted nationwide effort to deliver this message to nephrologists, surgeons, and interventional physicians during the past several years, with specific targets set forth for creation of fistulas and reduction of graft use. Curiously, nowhere in Kuo et al's article is this important fact acknowledged.