Umbilical vein grafts for vascular access in patients on long-term dialysis

Easy access to the vascular system is vital to any long-term dialysis program. The author's standard technique is an end-to-side radiocephalic arteriovenous fistula; grafts are reserved for situations in which a direct fistula is either impossible to construct or has failed. Although bovine and, more recently, expanded Teflon heterografts were successful initially, late failures from thrombosis or sepsis were not infrequent. Since February 1979, modified human umbilical vein has been used in patients needing a graft. It was used on 23 occasions in 21 patients. There were no early (within 30 days) failures. The overall patency rate from 2 to 26 months was 57%. Three infected grafts required removal, which was complicated by dense adhesion between the supporting Dacron mesh and adjacent tissues. No true aneurysms developed. After 1 year there was no obvious superiority of umbilical vein over expanded Teflon grafts. Longer follow-up is necessary to determine the ultimate role of umbilical vein grafts in patients on dialysis.