Early cannulation of bovine carotid artery grafts (Artegraft) after primary vascular access and fistula revision procedures.

Objective: Tunneled dialysis catheter (TDC) use has been associated with increased infectious complications and mortality in hemodialysis-dependent patients. Unfortunately, patients who undergo fistula revisions or creation of a new arteriovenous fistula frequently require a TDC during the postoperative period. Bovine carotid artery grafts (BCAGs) can be used as an early-access dialysis conduit to reduce TDC dependence. This study describes the performance of BCAGs that were cannulated early (<3 days) after implantation and associated clinical outcomes.
Methods: BCAGs were implanted in 63 consecutive dialysis-dependent patients. Patients and dialysis centers were directly provided early cannulation instructions; 31 (49%) patients were cannulated early, and of the 31 patients cannulated early, 21 (68%) were cannulated during the first postoperative day. Early complications, primary patency, secondary patency, and TDC incidence were monitored through clinic visits, hospital records, and phone calls to dialysis centers.
Results: The primary patency of BCAGs at 1 year in the early and late cannulation cohorts was 28% and 39%, respectively. The secondary patency of BCAGs at 1 year in the early and late cannulation cohorts was 74% and 77%, respectively. Early complications occurred in 11 (19%) patients who received a BCAG. There were no significant differences in complication rates between early and late cannulation patients. Of the 24 patients who underwent the operation without a pre-existing TDC, only three (13%) required TDC placement during the 30-day postoperative period.
Conclusions: BCAGs can be cannulated early without increased complication rates or a negative impact on midterm patency. Early cannulation of BCAGs obviates the need for a TDC postoperatively in dialysis-dependent patients undergoing primary vascular access or fistula revision procedures.
(Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)