Arterio-venous access utilizing modified bovine arterial grafts for hemodialysis

Forty-seven patients with chronic renal failure presenting with a loss of vascular access precluding hemodialysis were subjected to 105 surgical procedures to establish and to maintain an arteriovenous fistulae. 67 bovine heterografts were implanted over a 30 month period and observed for 6 or more months. Fifteen, or 32% of the patients, died during the study period. Eleven patients died with a functional fistula. Twenty fistulae continued to function at the end of 36 months constituting a 46.3% graft survival rate. Hemodialysis was continued in 11 of 12 patients via a P.T.F.E. Goretex graft or via a matured Brescia Fistula. The remaining patient experienced graft failure at the end of the study period. Graft thrombosis was observed in 31 of 67 grafts placed (46%). Successful thrombectomy was achieved in 52%. Fourteen grafts developed frank aneurysms with overt rupture in 8. All patients with aneurysms were negro. Six of 8 patients with aneurysm presented with severe hypertension. Thirteen aneurysms were resected without loss of life or limb. The use of bovine grafts in hypertensive negro patients is believed to be contraindicated.