Early Cannulation of Bovine Carotid Artery Graft Reduces Tunneled Dialysis Catheter-Related Complications: A Comparison of Bovine Carotid Artery Graft Versus Expanded Polytetrafluoroethylene Grafts in Hemodialysis Access

Vasc Endovascular Surg. 2019 Feb;53(2):104-111. doi: 10.1177/1538574418813595. Epub 2018 Nov 29.


Introduction:: In patients who receive chronic hemodialysis but do not have autogenous venous conduit for a native dialysis access, nonautologous grafts serve as an alternative conduit of choice. This study compared the clinical outcome of hemodialysis access using bovine carotid artery graft (BCAG) and prosthetic polytetrafluoroethylene (PTFE) graft in patients who receive chronic hemodialysis.

Methods:: An analysis of all patients undergoing hemodialysis using either BCAG or PTFE grafts from 2010 to 2017 was performed. Clinical outcomes were analyzed including graft patency as well as associated complications related to dialysis grafts and tunneled dialysis catheter (TDC).

Results:: During the study period, 142 patients received BCAG and 128 patients received PTFE graft implantation for dialysis access. The mean duration from graft implantation to graft cannulation in the BCAG and PTFE group was 12.3 ± 8.5 days versus 43.5 ± 16.4, respectively ( P = .01). Bovine carotid artery graft group had a higher 2-year primary patency rate (33% vs 14%, P = .03) and assisted primary rate (57% vs 23%, P = .02) compared to the PTFE group. The 2-year secondary patency rates were similar between the 2 groups (56% vs 53%, P = .69). Complication rates in the BCAG and PTFE group was 1.69 ± 0.24 per patient-year versus 2.54 ± 0.48 per patient-year, respectively ( P = .01). Tunneled dialysis catheter-related infection was greater in the PTFE group compared to the BCAG group (10.87 ± 2.61 vs 5.69 ± 0.98 per 1000 TDC days; P = .02). Bovine carotid artery graft cohorts group required a mean of 1.69 interventions per patient-year, compared to 2.76 per patient-year for the PTFE group ( P = .03).

Conclusions:: Bovine carotid artery graft permits earlier cannulation for hemodialysis access with superior primary and assisted primary patency rates compared to PTFE grafts. Patients with BCAG experienced shorter indwelling TDC duration and less TDC-related complications compared to PTFE cohorts.

Keywords: PTFE graft; artegraft; bovine carotid artery graft; early cannulation; hemodialysis; tunneled dialysis catheter.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Arteriovenous Shunt, Surgical / adverse effects
  • Arteriovenous Shunt, Surgical / instrumentation*
  • Bioprosthesis*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Carotid Arteries / transplantation*
  • Catheterization* / adverse effects
  • Catheters, Indwelling
  • Cattle
  • Databases, Factual
  • Female
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Heterografts
  • Humans
  • Male
  • Middle Aged
  • Polytetrafluoroethylene*
  • Prosthesis Design
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / instrumentation
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Upper Extremity / blood supply*
  • Vascular Patency
  • Young Adult


  • Polytetrafluoroethylene