A Three Year Experience Using Modified Bovine Arterial Heterografts for Vascular Access in Patients Requiring Hemodialysis

Abstract

From Jan. 1974-Dec. 1976, 28 arteriovenous fistulae were created in 24 uremic patients using modified bovine arterial heterografts. Bovine grafts were inserted only if the patient''s own vessels were deemed inadequate to permit the development of a useable Bresic fistula. Graft patency by the life-table method was 92% at 3 mo. and 75% at 1 yr. Complications leading to graft failure included late thrombosis, inadequate healing of skin flaps and graft disruption secondary to faulty cannulation. Ten patients died; none of the deaths were graft-related. At the end of the period of observation all patients requiring hemodialysis had functioning bovine grafts. For this purpose the modified bovine arterial heterograft is superior to any other currently available vascular conduit. The location of these grafts should be planned so as to make maximal use of distal vasculature and allow multiple sequential access procedures in the same extremity. An idealized approach which encompasses these principles is presented.