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However, pathophysiological analysis suggests that this practice may limit the overall resilience of the access. Perianastomotic collaterals serve a functional role as essential compensatory outflow pathways; in the presence of stenosis or obstruction of the primary venous segment, their patency maintains blood flow, reduces resistance, and prevents stagnation. Systematically preserving these branches, rather than ligating them, can significantly delay the onset of thrombotic events and ensure the functional survival of the access even if the main outflow fails. This \u201cconservative\u201d hemodynamic approach proposes a paradigm shift in surgical strategy, prioritizing vascular redundancy to improve long-term patency and minimize the need for complex salvage interventions.<\/jats:p>","DOI":"10.1177\/11297298261456369","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:10:02Z","timestamp":1781676602000},"page":"2045-2048","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preserving perianastomotic venous collaterals in arteriovenous grafts: A paradigm shift in outflow management"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4020-6187","authenticated-orcid":false,"given":"Andrea","family":"Gattuso","sequence":"first","affiliation":[{"name":"Vascular Surgery Unit, ASST Fatebenefratelli-Sacco, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Tadiello","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, ASST Fatebenefratelli-Sacco, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Heidempergher","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, ASST Fatebenefratelli-Sacco, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Antonietta","family":"Orani","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, ASST Fatebenefratelli-Sacco, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziano","family":"Porretta","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, ASST Fatebenefratelli-Sacco, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"issue":"1","key":"e_1_3_2_2_2","first-page":"1","article-title":"KDOQI 2019 Vascular Access Guidelines: What Is New","volume":"39","author":"Lok CE","year":"2022","unstructured":"Lok CE, Rajan DK. 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