Transrenal arteriovenous dialysis graft creation: survival and patency in a swine model

To investigate transrenal arteriovenous graft creation in an animal model and to report survival and patency.

Arteriovenous grafts were created from the renal artery to the renal vein in 10 swine. Renal access was accomplished with a combined percutaneous and transvascular approach. A reinforced 6-mm polytetrafluoroethylene conduit was tunneled between both flank access points, and stent-grafts were deployed from each of the renal origins into the conduit. Clopidogrel (10 mg per kilogram of body weight) was administered intravenously during the procedure, followed by a daily oral dose (75 mg) for up to 2 weeks. Animals were monitored with auscultation and angiography for up to 1 month; necropsy was performed in all animals.

Rapid arteriovenous flow at completion angiography was achieved in eight of 10 animals. Shunts were patent in five of six animals that were followed for 1 month. Diffuse pseudointimal hyperplasia was mild in three of six shunts and moderate in two (focal stenoses). Immediate thrombosis occurred in the first two animals when the clopidogrel bolus was administered after stent-graft deployment. These shunts were recanalized mechanically. Shunts were immediately patent in five of the six remaining shunts when the clopidogrel bolus was administered prior to stent-graft deployment. Complications occurred in four of 10 animals, three of which were euthanized within 1 week. The bowel was traversed in two animals, and renal vein laceration occurred during two procedures because of failure of the stent-graft delivery system.

Transrenal arteriovenous graft creation in swine is technically feasible, and long-term patency is possible with antiplatelet therapy.