Vascular access for chronic hemodialysis: use of bovine xenografts to create arteriovenous fistulas.

Adequate vascular access is the hallmark of successful chronic hemodialysis for end-stage renal disease. Between May 1975 and August 1975, it was necessary to use a bovine xenograft in 91 instances to create an arteriovenous fistula for vascular access in patients receiving chronic hemodialysis at the Vanderbilt University Affiliated Hospitals. Forty-two patients had one xenograft, 14 patients had two, and seven had three xenografts. Of all fistulas created with the xenografts, 53% were patent six months after the operation, 36% were patent at 12 months, and 15% have remained patent for 24 months. Thirty-seven percent of the xenografts failed during the first three months after operation. The most common reason for failure was thrombosis of the xenograft. Other complications encountered were false aneurysms, infection of the graft, ischemia of the extremity, and bleeding. Amputation of the lower extremity due to ischemia from septic emboli was necessary in one case. There was no deaths directly related to the use of these xenografts. It is out current opinion that the bovine xenograft should be reserved for use in patients who have had failure of the more conventional type of internal fistula (Cimino type). In selected patients in whom it is not possible to create a Cimino shunt, the xenograft offers adequate primary vascular access.