Comparison of Bovine Carotid Xenograft Versus Expanded Polytetrafluoroethylene Grafts for Forearm Loop Hemodialysis Access

Forearm loop grafts are a useful option for dialysis access in patients without suitable forearm veins. Bovine carotid artery (BCA) and expanded polytetrafluoroethylene (ePTFE) grafts are commonly used for this purpose, but no data exist to support the use of one over the other in the forearm loop conformation. We performed a retrospective review of 57 forearm loop grafts implanted at two institutions with a shared patient population between January 2009 and May 2017. Primary and secondary patency rates were calculated by univariate analysis and a Cox regression model adjusted for age, sex, and body mass index. There were 26 BCA and 31 ePTFE grafts placed during the study period. Mean follow-up was 37 ± 25 months. Primary and secondary patency rates in the BCA group were 71.7% and 83.6%, 54.8% and 71.1%, and 28.9% and 62.2% at 6, 12, and 24 months, respectively. In the ePTFE group, primary and secondary patency rates were 56.8% and 66.7%, 39.3% and 59.7%, and 26.9% and 40.4% at 6, 12, and 24 months (Fig). When adjusted for age, sex, and body mass index, secondary patency was significantly better with BCA compared with ePTFE (P = .04). Infection rates were 7% (two grafts) for BCA and 3% (one graft) for ePTFE. Bovine carotid xenografts in forearm loop configuration for hemodialysis access have improved secondary patency and similar infection rates compared with ePTFE forearm loops.