Natural Vein Graft?

[skyedogrocks]

Rob had met with a highly respected Vascular Surgeon at the Lahey Clinic Hospital today and discussed his failed upper arm fistula.  This was put in his arm in March with no sucess of using it.  Seems most of the vein is extremely narrow and deep.  The surgeon suggested doing a natural vein graft.  They are going to bring the fistula up to the surface of the arm and tie off all the tiny stray veins.  They will then take one of his bigger veins on the underarm of the same arm and tie it to the fistula, working as a natural graft.  The surgeon says he has an 80% chance that this will work.  It will be a 3 hour surgey, but we are hopeful this will work.  If not, it's onto the next arm with a permacath in the interim. 

Has anyone had this done?  Any success?

[silverhead]

Sharon had something similar, on the 4th attempt to get the fistula working, previous vein blew out, they tied that vein off and then took a vein from under her upper arm, removed it completely, and grafted it into the fistula artery (located just below the elbow)and a good looking vein just above the elbow, it matured beautifully and has worked for almost 2 years now, the needle sights are about 6 inches apart (probably closer to 9 inches if you follow the fistula path) so no real concerns about recirculation problems. I sure wish you luck with this attempt......
Tom

[petey]

My husband Marvin has a "magic" fistula, created by the ingenuity of an expert vascular surgeon.  He was in a situation where we didn't think he had anywhere else in his body to put a permanent access -- except the leg and he didn't want that at all.  In his right arm, he had three failed grafts (the looped plastic kind).  That arm was out.  In his left arm, he had one failed graft (upper arm) and one old fistula (wrist area) that had clotted off after his transplant years ago.  His surgeon at Duke (Durham, NC) talked to us about our possibilities.  It looked like we had no other place to go except the thigh.  We begged for any other option.

Then, the surgeon asked if we wanted to try an experiment.  He said he would take a long vein out of the back side of Marvin's left arm, slip it over to the inside of the forearm and strengthen it with a vein taken out of the thigh and moved to the arm.  He said it would be an access that had never been tried before at Duke but that he had read extensively and thought he might could make it work.  We asked for the chances of it working, and the surgeon said 10 percent.  The surgeon, Marvin, and I talked about it for over an hour.  If it worked, we were good to go.  If it didn't, we were back to square one and the leg would be next.  We decided it was worth the try.

The surgery took about four hours and the surgeon told me afterwards that it was pain-staking work on his part.  He is an excellent surgeon, and we love him -- he's been Marvin's surgeon for 10 years.  The magic fistula matured and worked beautifully, and now Marvin's been using it for over two years.  It is in the shape of a horseshoe, and every doctor, surgeon, neph, etc. we've seen since then is so impressed by it.  Several of them have argued with us that it's a graft (plastic) because of its shape, but we have to tell them -- No, it's a fistula -- it's all Marvin just from different places in his body.  The fistula is on the inside of his left arm (above the old wrist fistula and right below the bend of his elbow).

It is amazing what a good vascular sugeon can do.  However, we were at the point where we didn't think we had any other options that we could live with (a thigh access is not what Marvin wants), so we were willing to take a big risk.  For us, it paid off.

I hope things with work out for you and Rob.

[bolta72]

Best of luck to your husband. Did you go to American access at all.

[skyedogrocks]

On Friday, Rob had surgery on his upper arm fistula.  They took a vein from his right arm and fused it with his fistula to create the natural vein graft.  Poor guy was in a LOT of pain after the surgery.  Since it was so involved, they had to put him out totally.  It was over at 10:45 am and he didn't leave the hospital until 4:00 pm, he slept the whole way home and went right to bed.  He truly dislikes Percaset & Vicadyn, hates the way it makes him feel, so he took Tylenol w/Codine once that night.  Regular tylenol is working for him now.  He was able to get up on Saturday morning and move around.  He stayed home today, but is feeling really good.  He has loads of brusing and the length of the incision is amazingly long.

I was so worried that I didn't want to discuss it and jinx anything until after the surgery.  We'll know in about 2-3 weeks how well it took.  The Surgeon was pleased that the humming is much stronger, even his lower arm fistula sounds stronger.  I really hope this works and he doesn't have to have a fistula put in his right arm.  He was so brave, he truly is my hero.

[silverhead]

That sure is encouraging news about the graft, best of luck with it, Sharon also will not take anything stronger than a Tylenol #3, anything stronger knocks her out like a light, when She had her vein graft done they gave her a shot of Demerol in spite of us giving them loud notice that she cannot tolerate heavy dose narcotics, she was so out of it for the next 5 days that she could not even keep her normal daily meds down, it really fouled her up for some time, when we told her Neph about it he came right out of his chair and practically screamed that you NEVER give Demerol to a kidney patient, we did the whole complaint thing thru the hospital and the state medical board, but nothing came of it, they circled the pros and protected the anesthetist, but when we go to the hospital now they seem very aware of her allergies now......