Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients.

Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.