The arm loop graft is placed when the forearm and upper arm fistula options are gone, and when the brachial artery near the elbow is too small. This option is frequently chosen in the fifteen to eighteen percent of patients who have “high-bifurcation”, a situation where the brachial artery divides into two smaller arteries in the upper arm instead of below the elbow as usual. Unlike the standard arm graft, the blood flow is from top to bottom in the front of the arm, and sometimes the dialysis staff will “run the patient backward”, leading to inefficient dialysis