Arterio-venous Access Utilizing Modified Bovine Arterial Grafts for Hemodialysis

Abstract

Patients (47) with chronic renal failure presenting with a loss of vascular access precluding hemodialysis were subjected to 105 surgical procedures to establish and maintain an arteriovenous fistulae. Bovine heterografts (67) were implanted over a 30 mo. period and observed for 6 or more mo. Fifteen (32%) patients died during the study period. Eleven patients died with a functional fistula. Twenty fistulae continued to function at the end of 36 mo., constituting a 46.3% graft survival rate. Hemodialysis was continued in 11 of 12 patients via a Goretex graft or a matured Brescia Fistula. The remaining patient experienced graft failure at the end of the study period. Graft thrombosis was observed in 46% of grafts placed. Successful thrombectomy was achieved in 52%. Grafts (14) developd frank aneurysms with overt rupture in 8. All patients with aneurysms were Negro. Of 8 patients, with aneurysms, 6 presented with severe hypertension. Aneurysms (13) were resected without loss of life or limb. The use of bovine grafts in hypertensive Negro patients is apparently contraindicated.