Surgical technique for creation of an arteriovenous fistula using a looped bovine graft.

We have used bovine grafts in a looped configuration in the forearn in 150 patients for chronic hemodialysis and have evolved a simple technique for their successful implantation. The critical technical points include: 1) use of large-diameter long grafts (7.0-8.0 mm diameter; 34-40 cm in length); maintenance of the heterograft in a distended and pulsating state throughout the procedure to prevent distortion and twisting; 3) creation of a wide smooth-looped tunnel with Bakes dilators; and 4) anastomosis to the largest avialable antecubital vein. Thirteen cases of late graft occlusion (3-36) months) have been found to be produced by a localized obstructive lesion just distal to the venous anastomosis. These grafts were easily restored to a functional status by thrombectomy and patch graft angioplasty of the stenotic segment. The looped graft technique is not applicable to all patients requiring hemodialysis but it is especially helpful when distal vessels have been obliterated by previous procedures or when home-dialysis is planned. This surgical technique should be among the alternatives considered by surgeons concerned with problems of vascular access in patients with chronic renal failure.