Vascular Access Grafts for Chemotherapy Use in Forty Patients at M. D. Anderson Hospital

Abstract

Arteriovenous grafts (42) were placed to provide vascular access in 40 patients with poor or sclerosed superficial veins. Patients (39) had malignant disease and required chemotherapy, while 1 patient with aplastic anemia needed frequent transfusions. Grafts (32) were placed in the arm (27 straight and 5 loop), and 10 in the leg (femoral-femoral loop). Shunts (37) consisted of 6 mm poly-tetrafluoroethylene (PTFE), and 5 were 6 mm Dacron. The straight brachial artery to axillary vein PTFE graft was preferred, while the PTFE femoral loop graft was a satisfactory alternative. The loop arm graft was associated with a high complication rate and is no longer used. Local anesthesia was employed in all cases except for a 3 yr old child. There was no operative mortality and no severe morbidity, despite subsequent myelosuppression by chemotherapeutic agents injected via these grafts. Thirty patients are alive, while 10 died of their malignancy. Twenty-six grafts are functional and have been in place in average 4.4 mo. (range: 1-14 mo.). Acceptance by patients and particularly by personnel in the out-patient chemotherapy unit has been enthusiastic. Vascular access grafts can be inserted safely and provide a convenient route for drawing blood samples, and for administering chemotherapy and intermittent i.v. therapy in selected patients with neoplastic disease.