The use of modified umbilical vein graft as vascular access in chronic hemodialysis

The selection of material of an arteriovenous graft employed for maintenanc e hemodialysis when natural veins are lacking is of major importance for it s patency rate because of rough handling during hemodialysis, because of mu ltiple needling, and because of other risk factors related to the patient's physical condition. The authors studied 148 umbilical vein grafts implante d in the last 7 years in 123 patients for maintenance hemodialysis. During a 3-year follow up, 83 grafts were lost because of a total number of 137 co mplications in 103 grafts, despite the invasive and noninvasive attempts at graft rescue. The most frequent cause of graft loss was thrombosis, observ ed in 87 grafts, causing graft loss in 57. The remaining 50 complications o bserved were bleeding in seven, aneurysm formation in six, infection in 16, and venostasis or steal syndrome in 21 grafts. Twenty-four of these were r escued, while seven patient deaths were seen with functioning graft. The go od biocompatibility of the umbilical vein grafts allowed for multiple inter ventional and surgical procedures toward graft rescue, which prolonged pate ncy rate. The cumulative patency rate was 72.2 +/- 5.9%, 54.4 +/- 6.2%, and 31.7 +/- 9.2% for the first, second, and third year, respectively. The pat ency rate is considered satisfactory in view of the prolonged time under he modialysis and the advanced age of the patients of our study.