There are many ways to create arteriovenous shunts for hemodialysis. The simplest way is to connect the vein to the artery at the wrist via a small incision. However, many patients may not have open veins over there forearm due to multiple hospitalization and blood drawn or angiocath placement. These patients’ veins from the upper arm are utilized to create arteriovenous shunts and sometimes it may require more involved operation.

There are many patients who simply have run out open veins most likely due to their anatomy or multiple Angiocath placements. These patients a conduit (ePTFE, collagen-based, or Autogenous) is used to connect the artery to the vein and serve as the axis side for the dialysis cannula for the hemodialysis. There are few patients who have had multiple operations for creations of arteriovenous fistula/graph with failure. These patients simply have no larger veins to connect the conduit to. In these patients a new method called hero catheter is used to direct the flow directly into the heart from the upper and/or lower extremities arteries.