Experience with arterial substitutes in the construction of vascular access for hemodialysis

Thirty autogenous saphenous vein grafts, 91 modified bovine heterografts and 96 PTFE grafts were used in the construction of vascular access for hemodialysis. The indication for the use of an arterial substitute was the unavailability of suitable artery or vein for the construction of a standard subcutaneous arterio-venous fistula. Ten of these grafts were placed in the lower extremity while the rest were placed in either the forearm or upper arm. All three types of grafts provided an immediate satisfactory solution to a difficult problem. When compared in terms of longterm patency, the autogenous saphenous vein proved to be inferior to either the modified bovine heterograft or the PTFE graft. Comparing all three grafts, the PTFE graft is currently our vascular substitute of choice for patients requiring grafts for arteriovenous fistulas for hemodialysis.