[Vascular access lines: use of biologic grafts]

To ensure vascular access, a biological graft was inserted in 44 patients from August 1982 to February 1985 at the Department of Urology, Pitié Hospital, Paris. Forty-nine grafts were used, including 39 saphenous veins and 10 carotid arteries from calves. Four patients free of renal failure had insertion of a graft to allow chemotherapy (3 cases) or plasmapheresis (1 case). Graft patency rate in these four patients is 50%. Among the 40 patients with renal failure, 11 have not yet had dialysis, 26 are currently under dialysis, 2 have been lost to follow up, and 1 died before dialysis. All but one of the patients with renal failure not treated by dialysis have a patent graft. Graft patency rate after one year in the 26 patients under dialysis is 83% for non-reoperated patients and 91% for reoperated and non-reoperated patients as a group. As concerns complications, an interesting fact is that thrombosis of the graft usually required graft replacement, whereas most delayed stenoses were treated by surgery with preservation of the graft. No case of infection or aneurysm was recorded throughout follow up. These results pertain chiefly to saphenous vein grafts as use of carotid arteries from calves is recent. In view of the 95% immediate graft patency rate and of the satisfactory results at one year in these patients usually selected because of the poor condition of accessible arteries and veins, we believe biologic grafts constitute an outstanding material in vascular access surgery for hemodialysis.