Abstract
Forty-two arteriovenous grafts were placed to provide vascular access in 40 patients with poor or sclerosed superficial veins. Thirty-nine patients had malignant disease and required chemotherapy, while one patient with aplastic anemia needed frequent transfusions. Thirty-two grafts were placed in the arm (27 straight and 5 loop), and ten in the leg (femoral-femoral loop). Thirty-seven shunts consisted of 6 mm polytetrafluoroethylene (PTFE), and five were 6 mm Dacron®. The straight brachial artery to axillary vein PTFE graft was preferred, while the PTFE femoral loop graft was a satisfactory alternative. The loop arm graft was associated with a high complication rate and is no longer used. Local anesthesia was employed in all cases except for a 3-year-old child. There was no operative mortality and no severe morbidity, despite subsequent myelosuppression by chemotherapeutic agents injected via these grafts. Thirty patients are alive, while ten died of their malignancy. Twenty-six grafts are functional and have been in place an average 4.4 months (range: 1 to 14 mo.). Acceptance by patients and particularly by personnel in the out-patient chemotherapy unit has been enthusiastic. Vascular access grafts can be inserted safely and provide a convenient route for drawing blood samples, and for administering chemotherapy and intermittent intravenous therapy in selected patients with neoplastic disease.
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- Anderson C. B., Codd J. R., Graff R. A., Groce M. A., Harter H. R., Newton W. T. Cardiac failure and upper extremity arteriovenous dialysis fistulas. Case reports and a review of the literature. Arch Intern Med. 1976 Mar;136(3):292–297. [PubMed] [Google Scholar]
- Bottino J., McCredie K. B., Groschel D. H., Lawson M. Long-term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases. Cancer. 1979 May;43(5):1937–1943. doi: 10.1002/1097-0142(197905)43:5<1937::aid-cncr2820430554>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
- Bowers D. G., Jr, Lynch J. B. Adriamycin extravasation. Plast Reconstr Surg. 1978 Jan;61(1):86–92. doi: 10.1097/00006534-197801000-00015. [DOI] [PubMed] [Google Scholar]
- Brescia M. J., Cimino J. E., Appel K., Hurwich B. J. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966 Nov 17;275(20):1089–1092. doi: 10.1056/NEJM196611172752002. [DOI] [PubMed] [Google Scholar]
- Buckley C. J., Manning L. G., Page C. P. Experience with central high flow arteriovenous fistulas in patients requiring chronic parenteral chemotherapy or hemodialysis. Am J Surg. 1978 Dec;136(6):730–734. doi: 10.1016/0002-9610(78)90346-x. [DOI] [PubMed] [Google Scholar]
- Burdick J. F., Scott W., Cosimi A. B. Experience with dacron graft arteriovenous fistulas for dialysis access. Ann Surg. 1978 Mar;187(3):262–266. doi: 10.1097/00000658-197803000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Butler H. G., 3rd, Baker L. D., Jr, Johnson J. M. Vascular access for chronic hemodialysis: polytetrafluoroethylene (PTFE) versus bovine heterograft. Am J Surg. 1977 Dec;134(6):791–793. doi: 10.1016/0002-9610(77)90326-9. [DOI] [PubMed] [Google Scholar]
- Ehrenfeld W. K., Grausz H., Wylie E. J. Subcutaneous arteriovenous fistulas for hemodialysis. Am J Surg. 1972 Aug;124(2):200–206. doi: 10.1016/0002-9610(72)90014-1. [DOI] [PubMed] [Google Scholar]
- GREGG D. E., SABISTON D. C., Jr, THEILEN E. O. Physiologic studies in experimental high output cardiac failure produced by aortic-caval fistula. Surg Forum. 1956;6:233–237. [PubMed] [Google Scholar]
- Goldman D. A., Maki D. G., Rhame F. S., Kaiser A. B., Tenney J. H., Bennett J. V. Guidelines for infection control in intravenous therapy. Ann Intern Med. 1973 Dec;79(6):848–850. doi: 10.7326/0003-4819-79-6-848. [DOI] [PubMed] [Google Scholar]
- Haimov M., Jacobson J. H., 2nd Experience with the modified bovine arterial heterograft in peripheral vascular reconstruction and vascular access for hemodialysis. Ann Surg. 1974 Sep;180(3):291–295. doi: 10.1097/00000658-197409000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levey R. H., Sallen S., Weinstein H., Jaffe N. Surgical techniques for vascular access for chemotherapy in infants and children. J Pediatr Surg. 1978 Dec;13(6D):724–729. doi: 10.1016/s0022-3468(78)80122-5. [DOI] [PubMed] [Google Scholar]
- Ryan J. A., Jr, Abel R. M., Abbott W. M., Hopkins C. C., Chesney T. M., Colley R., Phillips K., Fischer J. E. Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med. 1974 Apr 4;290(14):757–761. doi: 10.1056/NEJM197404042901401. [DOI] [PubMed] [Google Scholar]
- Sack G. H., Jr, Levin J., Bell W. R. Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features. Medicine (Baltimore) 1977 Jan;56(1):1–37. [PubMed] [Google Scholar]
- Steckler R. M., Martin R. G., Speer J. F., McCredie K. B. Vascular access by means of surgically created arteriovenous fistulas in the chemotherapy of acute leukemia: a preliminary report. South Med J. 1974 Jul;67(7):821–824. doi: 10.1097/00007611-197407000-00018. [DOI] [PubMed] [Google Scholar]
- Tellis V. A., Kohlberg W. I., Bhat D. J., Driscoll B., Veith F. J. Expanded polytetrafluoroethylene graft fistula for chronic hemodialysis. Ann Surg. 1979 Jan;189(1):101–105. doi: 10.1097/00000658-197901000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]

