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Diagnostic Imaging of and Radiologic Intervention for Bovine Ureter Grafts Used as a Novel Conduit for Hemodialysis Fistulas

Dinuke R. Warakaulle1,2, Amlyn L. Evans1, Alison J. Cornall3, Christopher R. Darby4, Philip Boardman1 and Raman Uberoi1

1 Department of Radiology, The Churchill Hospital, Oxford, United Kingdom.
2 Department of Radiology, The John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
3 Department of Nephrology, The Churchill Hospital, Oxford, United Kingdom.
4 Department of Vascular Surgery, The Churchill Hospital, Oxford, United Kingdom.


Figure 1
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  		Fig. 1A —Sonograms from routine vascular duplex study of 63-year-old woman show SynerGraft 100 (SG 100 [CryoLife Inc.]). Axial (A) and longitudinal (B) images from routine vascular duplex study show normal appearances of SG 100. Conduit has walls that appear considerably thicker than those seen with autogenous venous hemodialysis fistulas. Wall has inner and outer echogenic layers with middle hypoechoic layer.

 

Figure 2
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  		Fig. 1B —Sonograms from routine vascular duplex study of 63-year-old woman show SynerGraft 100 (SG 100 [CryoLife Inc.]). Axial (A) and longitudinal (B) images from routine vascular duplex study show normal appearances of SG 100. Conduit has walls that appear considerably thicker than those seen with autogenous venous hemodialysis fistulas. Wall has inner and outer echogenic layers with middle hypoechoic layer.

 

Figure 3
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  		Fig. 2A —False aneurysm is seen at arterial anastomosis in femoral loop SynerGraft 100 (SG 100 [CryoLife Inc.]) of 74-year-old man. Duplex sonography (A) and digital subtraction fistulography (B) images show false aneurysm at arterial anastomosis in femoral loop SG 100.

 

Figure 4
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  		Fig. 2B —False aneurysm is seen at arterial anastomosis in femoral loop SynerGraft 100 (SG 100 [CryoLife Inc.]) of 74-year-old man. Duplex sonography (A) and digital subtraction fistulography (B) images show false aneurysm at arterial anastomosis in femoral loop SG 100.

 

Figure 5
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  		Fig. 3A —Tight stenosis is seen at anastomotic site of SynerGraft 100 (SG 100 [CryoLife Inc.]) and axillary vein in 59-year-old woman. Duplex sonography (A) and digital subtraction fistulography (B and C) images show stenosis. Patient underwent successful percutaneous transluminal fistuloplasty.

 

Figure 6
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  		Fig. 3B —Tight stenosis is seen at anastomotic site of SynerGraft 100 (SG 100 [CryoLife Inc.]) and axillary vein in 59-year-old woman. Duplex sonography (A) and digital subtraction fistulography (B and C) images show stenosis. Patient underwent successful percutaneous transluminal fistuloplasty.

 

Figure 7
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  		Fig. 3C —Tight stenosis is seen at anastomotic site of SynerGraft 100 (SG 100 [CryoLife Inc.]) and axillary vein in 59-year-old woman. Duplex sonography (A) and digital subtraction fistulography (B and C) images show stenosis. Patient underwent successful percutaneous transluminal fistuloplasty.

 

Figure 8
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  		Fig. 4 —Photomicrograph of resected SynerGraft 100 (SG 100 [CryoLife Inc.]) specimen from 69-year-old man. SG 100 had venous anastomotic stenosis. Marked fibroproliferative intimal thickening with neointima projecting into lumen at anastomotic site is present. (H and E)

 

Figure 9
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  		Fig. 5A —Two stenoses in SynerGraft 100 (SG 100 [CryoLife Inc.]) of 72-year-old woman. Digital subtraction fistulography images show stenoses have been dilated using cutting balloon with good technical result.

 

Figure 10
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  		Fig. 5B —Two stenoses in SynerGraft 100 (SG 100 [CryoLife Inc.]) of 72-year-old woman. Digital subtraction fistulography images show stenoses have been dilated using cutting balloon with good technical result.

 

Figure 11
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  		Fig. 6 —Kaplan-Meier curves of estimated primary (dashed line) and secondary (solid line) patencies of SynerGraft 100 (SG 100 [CryoLife Inc.]) hemodialysis fistulas. Patency (functioning graft) is plotted as percentage on y-axis. Censored observations are indicated by upstrokes.

 

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