THE CREATION OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS BY THE USE OF BOVINE HETEROGRAFT : EARLY TERM RESULTS

Materials and Method: Between December 2003 and April 2004, the arteriovenous fistulas were created by the use of 6 mm Procol graft for hemodialysis in 10 patients with end stage renal disease in our clinic. Seven patients were female and three were male. Six patients had diabetus mellitus. Two patients had three previous arteriovenous fistulas, five patients had four previous four arteriovenous fistulas, two patients had five previous arteriovenous fistulas and one patient had six previous arteriovenous fistulas.

Results: The mean age of patients was 54.2 ± 7.9 years. Brachial artery was used in eight patients and femoral artery was used in two patients. In the upper extremity, the graft was a loop-configured forearm access in six cases and was anastomosed totally to the upper-arm veins (basilic and axillary vein) in two cases. The grafts were used as a loop-configurated interposition graft between the superficial femoral artery and long saphenous vein in the thigh. The mean follow-up was 6.3 ± 1.3 months (ranged from 4 to 8 month). Graft thrombosis occurred postoperatively on the first day of two cases and occurred three months after operation in one case. Surgical thrombectomy was performed and graft patency was restored in these cases. The cases in where thrombosis occurred on the first day after operation, the fistulas existed in upper-arm and in thigh. The fistula of the patient whose thrombosis occurred in 3 months postoperatively was in forearm. The patient whose graft thrombosis occurred in the thigh had six previous arteriovenous fistulas. In this patient, graft thrombosis occurred in 2 months postoperatively and surgical thrombectomy was performed. Graft patency was performed again. In the 7th month after operation, graft thrombosis occurred again. The thrombectomy performed was unsatisfactory and the graft patency failed. The second patient whose arteriovenous fistula manifested in the thigh applied in the third month after operation due to the prolonged bleeding from the needle puncture site in the graft. Bleeding was controlled by prolonged compression. None of the patients was observed to develop any aneurysm in the follow-up period.

Conclusion: Because of its lower complication and increased patency rates, the arteriovenous fistula accomplished by ProCol graft may be a good choice for patients who have no suitable native vein available for creation of autogenous arteriovenous fistula. (Turkish J Vasc Surg 2005;14(3):27-32).