THE SEARCH for a technique of graft replacement or bypassing of the inferior vena cava has met with little or no success both experimentally and clinically, irrespective of the type of graft material used. The main reasons for the failure of achieving inferior vena cava graft patency have been attributed to low pressure, low flow rate, and fibrous reaction around the implants. In an attempt to overcome some of these hemodynamic factors which promote thrombosis, a few investigators have reported experiments designed to increase venous pressure and accelerate the blood flow rate through the graft. Thus Kunlin in 19531 suggested the use of an arteriovenous (AV) fistula in order to enhance the venous pressure so as to prevent secondary stenosis of the distal anastomosis and thereby achieve patency of the graft. The two cases reported by this author dealt with peripheral veins and resulted in failure. Later, in 1958,