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An Alternative Natural Vascular Access Graft

By Susan Eymann, MS16 Jan 2019

A working vascular access is the lifeline for a hemodialysis patient. It is also an Achilles heel, for when it fails, another access (frequently a catheter) must be quickly placed for life preserving hemodialysis to continue. While an arteriovenous fistula (a natural conduit connecting an artery and a vein) is the preferred vascular access, expanded polytetrafluoroethylene (ePTFE) synthetic grafts are frequently used as the second choice for a vascular access, before placing a catheter.

A lesser know graft alternative is a bovine carotid artery graft (BCA) named Artegraft.1 Screen Shot 2019-01-11 at 9.24.49 AMBCA’s biological material consists of a flexible tightly woven, cross-linked fibrous matrix. Artegraft was the first vascular graft approved by the FDA in 1970 and has been in continuous clinical use for over 45 years. Its natural collagen matrix offers surgeons a natural biological alternative to synthetic grafts or to a non-viable autogenous fistula. Once implanted, it can be cannulated for hemodialysis ten days after implantation in the same manner, at a 25-30° angle, that a native fistula is cannulated.

Artegraft can be used as a functional hemodialysis access

  • When a native fistula has failed or is immature

  • When a native fistula’s outflow is occluded

  • When there is recurrent clotting of ePTFE grafts or fistulas

  • As an interposition graft in an anuerysmal fistula

  • As a bypass around infected fistula segments

  • For an access in the lower thigh

  • As an inflow conduit during ischemic steal

  • Proximalization of arterial flow (PAI)
  • Distal Revascularization and Interval ligation (DRIL)

Although predominantly used as a hemodialysis graft, Artegraft is also approved for use at other sites and applications including distal to the aorta, for segmental bypasses, arterial replacement, patch graft, and for a femoropopliteal bypass when the patient’s saphenous is absent or inadequate. It is available in multiple sizes to match a host vessel. Stored and preserved in alcohol in a bottle, the Artegraft manufacturers call it a “fistula in a bottle” because of its natural composition. Similar to a fistula, intraoperative flow using transit time ultrasound technology can be measured on bovine grafts to help identify the cause of steal syndrome.2

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2Chemla ES, Tang VC, Eyman SA, Intraoperative flow measurements are helpful in the treatment of high-inflow steal syndrome on a predialysis patient with a brachiocephalic fistula: a case report. Ann Vasc Surg. 2007 Sep;21(5):645-7.