Vascular access for dialysis. Technics and results with newer methods.

Over a five year period, 114 patients had one or more secondary operations for access to the circulation for hemodialysis, these being a Thomas femoral shunt, saphenous vein graft, or Sparks mandril graft. The patient group was different from the general dialysis population, containing more females, more patients with diabetes, and more patients with collagen-vascular disease. Comparing duration of utility by the life table method for each technic, the femoral shunt lasted longest but with a high incidence of septic complications, the mandril graft was intermediate, and the saphenous vein graft least durable in use. The mandril is considered a tentative first choice for secondary access when the required maturation time is available.