Vascular access grafts for chemotherapy. Use in forty patients at M. D. Anderson Hospital

Forty-two arteriovenous grafts were placed to provide vascular access in 40 patients with poor or sclerosed superficial veins. Thirty-nine patients had malignant disease and required chemotherapy, while one patient with aplastic anemia needed frequent transfusions. Thirty-two grafts were placed in the arm (27 straight and 5 loop), and ten in the leg (femoral-femoral loop). Thirty-seven shunts consisted of 6 mm polytetrafluoroethylene (PTFE), and five were 6 mm Dacron((R)). 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-year-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 ten died of their malignancy. Twenty-six grafts are functional and have been in place an average 4.4 months (range: 1 to 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 intravenous therapy in selected patients with neoplastic disease.