Vascular access for hemodialysis by bovine graft arteriovenous fistulas.

A technique has been developed for vascular access in chronic dialysis using bovine graft arteriovenous fistulas in the forearm. Indications for use of bovine arteriovenous fistulas are failures of arteriovenous shunts and standard arteriovenous fistulas at the wrist or as a primary procedure in the event that arterial inflow or venous outflow are inadequate. Choice of either a straight or loop graft is dictated by the vascular anatomy. Loop grafts, orginating from the brachial artery, should be used for inflow problems; straight grafts, originating from an artery at the wrist, should be used for outflow problems. Results have been excellent in this series of 39 grafts in 36 patients observed from two months to one year with a follow-up average of six months. Ninety per cent of the grafts continue to function or functioned until successful transplantation or the death of the patient. Advantages of bovine graft arteriovenous fistulas compared with other fistulas include ease of access, high flows and decreased incidence of hematomas. The major complication has been thrombosis, and this incidence, most likely, can be decreased by more careful selection of the type of graft placement according to the vascular anatomy.