difficult dialysis access creation- chest loop

This is a dialysis patient with exhausted bilateral arm's venous property. Due to the need of long term dialysis, I have created a anterior chest loop graft for her some 6 years ago. And fortunately, the anterior chest dialysis graft lasted functional for over 6 years. Several weeks ago, because of the degenration of the graft, low flow with frequent thrombosis was noted.
My stratagy is : insert a cuffed tunneled catheter via the right internal jugular vein for dialysis and perform a anterior chest dialysis graft redo procedure. I have implanted a new graft and do the anastomosis of either end of the graft to the original graft inlet and outelt stumps.

I think, with meticulous work and proper clinical judgment, we still can perform dialysis graft for long term usage on those patients whose bilateral arm are not suitable for graft creation. The anterior chest loop graft is one of the form which can/should be considered.