Biological Grafts for Hemodialysis Access: Historical Lessons, State-of-the-Art and Future Directions
Article first published online: 22 AUG 2012
© 2012 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 26, Issue 2, pages 233–239, March/April 2013
How to Cite
Dukkipati, R., Peck, M., Dhamija, R., Hentschel, D. M., Reynolds, T., Tammewar, G. and McAllister, T. (2013), Biological Grafts for Hemodialysis Access: Historical Lessons, State-of-the-Art and Future Directions. Seminars in Dialysis, 26: 233–239. doi: 10.1111/j.1525-139X.2012.01106.x
- Issue published online: 21 MAR 2013
- Article first published online: 22 AUG 2012
The vast majority of arteriovenous grafts (AVG) have been constructed using expanded polytetrafluoroethylene (ePTFE). While ePTFE grafts have the advantage of being relatively inexpensive and easy to manufacture, distribute, ship, and store, their primary patency rates are disappointing when compared with the native AVF. Though use of arteriovenous fistulas (AVF) in the United States has increased substantially, approximately 25% of hemodialysis patients continue to use AVG as their vascular access. We present here a comprehensive review of biological grafts and their use in hemodialysis vascular access. In this review, we discuss the use of synthetics and then explore the evolution of biological grafts over the past 20 years, their clinical impact, and future challenges in widespread clinical use in hemodialysis patients. Provided are in depth descriptions of currently used nonbiological arteriovenous grafts and the recent approaches in increasing the patency of synthetic grafts. Recent technological advances using tissue-engineered AVGs have shown promise for patients receiving hemodialysis and their potential to provide an attractive, viable option for vascular access have been discussed.