Comparing vascular access methods

Adequate AV access remains the key to long-term survival of patients having ESRD requiring maintenance hemodialysis. The standard AV fistula described by Brescia and Cimino remains the time proven preferred hemodialysis AV access. However, the overwhelming majority of ESRD patients have inadequate, absent, or thrombosed vasculature preventing surgical creation of the fistula bringing out the necessity for prosthetic grafts. The Bovine heterograft, although associated with increased primary thrombosis and a shorter duration of patency, does offer greater stimulation of fibroblastic ingrowth in some patients with predictable poor healing characteristics. The reinforced PTFE (Gore-Tex) graft for construction of a bridged AV fistula has proven to be a valuable, reliable prosthetic with a minimum complication rate and the longer duration of patency when used as AV access. The physical characteristics and physiological properties of Gore-Tex and Bovine grafts are reviewed in Table II.