A five-year experience with the bovine heterograft for vascular access.
We retrospectively analyzed 385 bovine heterografts inserted in 331 patients receiving dialysis to determine patency and complication rates. Eighty-two grafts were inserted in diabetics, 303 in nondiabetics; 129 were primary grafts, 256 secondary. There were 251 "distal" grafts using the distal radial artery and 134 "proximal" grafts using the distal brachial artery (127 grafts) or the superficial femoral artery (seven grafts). During this five-year interval, 209 complications were identified with the most prevalent being thrombosis (160), aneurysms (18), and puncture site (18) or wound (eight) infections. An aggressive surgical approach to these complications prolonged graft patency, as evidenced by only 82 irreversible graft failures. The overall patency rate at one through four years was 79%, 69%, 63%, and 51% respectively. One- and two-year patency for diabetics (81%, 74%) vs nondiabetics (78%, 70%), primary (85%, 77%) vs secondary grafts (73%, 64%), and proximal (80%, 66%) vs distal grafts (75%, 64%) were not significantly different. Long-term patency was unaffected by diabetes, previous access procedures, or graft location.
D000783:Aneurysm / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical; D001705:Bioprosthesis / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology