The Use of Modified Umbilical Vein Graft as Vascular Access in Chronic Hemodialysis

Abstract

The selection of material of an arteriovenous graft employed for maintenance hemodialysis when natural veins are lacking is of major importance for its patency rate because of rough handling during hemodialysis, because of multiple needling, and because of other risk factors related to the patient's physical condition. The authors studied 148 umbilical vein grafts implanted 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 complications in 103 grafts, despite the invasive and noninvasive attempts at graft rescue. The most frequent cause of graft loss was thrombosis, observed in 87 grafts, causing graft loss in 57. The remaining 50 complications observed were bleeding in seven, aneurysm formation in six, infection in 16, and venostasis or steal syndrome in 21 grafts. Twenty-four of these were rescued, while seven patient deaths were seen with functioning graft. The good biocompatibility of the umbilical vein grafts allowed for multiple interventional and surgical procedures toward graft rescue, which prolonged patency 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 patency rate is considered satisfactory in view of the prolonged time under hemodialysis and the advanced age of the patients of our study.