The arteriovenous fistula (AVF) for hemodialysis is the gold standard of vascular access. However, it is not feasible in all patients. Arterio-venous graft (AVG) is a second viable option as an alternative to tunnelled central venous catheter (tCVC). However, grafts are burdened with more complications, have a shorter life patency and require adequate monitoring and maintenance. Two clinical cases presented here illustrate how combined multiple surgical and endovascular strategies, in a complementary and synergistic fashion, can ensure long-term patency and reduce the use of the CVC.
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