Introduction: End-stage renal disease (ESRD) patients require long-term maintenance hemodialysis, and a stable vascular access is crucial.  Some patients cannot establish one due to poor vascular conditions and must rely on prosthetic grafts (e.g., PTFE grafts). However, infection of prosthetic grafts is one of the most serious complications in dialysis access management, typically requiring removal of the infected graft and staged construction of a new access at a different site. 
Method: A retrospective analysis was conducted on five patients treated at our hospital between February 2024 and February 2025 who required unconventional dialysis access construction. Among them, two patients had extremely poor peripheral vasculature and multiple prior failed AVF surgeries; for these patients, a cryopreserved cadaveric donor iliac artery was used to construct a U-shaped arteriovenous fistula in the upper arm. The other three patients presented with infection involving the cannulation segment of an existing PTFE graft fistula. Donor iliac arteries were obtained via the organ procurement organization (OPO) from voluntary deceased donors, then decellularized and cryopreserved until use. 
Results: All five patients successfully underwent hemodialysis access reconstruction using cryopreserved allogeneic vascular grafts. Postoperative ultrasound showed graft lumen diameters of approximately 6.0–6.8 mm and blood flow rates exceeding 1000 mL/min. Initial dialysis cannulation was performed beginning on postoperative day 28, with pump speeds of 240–280 mL/min, stable venous pressures, and effective hemostasis at puncture sites after needle withdrawal. None of the patients exhibited signs of infection after surgery (such as fever, abscess, or wound discharge), and all infection markers returned to normal levels within one week. Over a follow-up period of 3–12 months, no complications were observed, including graft thrombosis, stenosis, pseudoaneurysm, or re-infection. Notably, in the three patients who had initially been advised to undergo complete graft removal, replacing only the infected segment while retaining the graft’s main trunk obviated the need to create a new central venous access and a second surgery, thereby preserving valuable vascular access resources. All patients were satisfied with the new dialysis access, and none experienced any difficulties with cannulation or bleeding at the access site.


Conclusion: This study is the first in China to successfully perform and systematically review the use of cryopreserved allogeneic vascular grafts for establishing dialysis access and for replacing infected graft segments (five cases in total). The results demonstrate that this technique is highly feasible and safe for patients with extremely poor vascular conditions or complex access infections, yielding high postoperative patency rates and good cannulation outcomes, and thus offering significant clinical advantages.