Massive aneurysmal dilatation of a depopulated ureteric hemodialysis xenograft

Abstract

Use of depopulated bovine ureteric xenografts for hemodialysis vascular access has recently been described. Cellular components have been removed, giving a connective tissue matrix which can be neocellularized, retaining native biomechanics. A 24-year-old male with end-stage renal disease from focal segmental glomerulosclerosis presented with particularly difficult vascular access. A depopulated bovine ureteric xenograft was implanted from the left subclavian artery to innominate vein. It became massively aneurysmal, requiring emergency embolization. Biopsy of the graft stained positive for alpha-gal. We believe this is the first reported case of massive aneurysmal dilatation of a depopulated bovine ureteric xenograft.

Long-Term Results of Biological Grafts for Haemodialysis Vascular Access

“…Massive aneurysmal dilatation of a bovine ureter used in a subclavian artery to innominate vein fistula is described; and in a small series (n = 9) from the same institution the rate of aneurysm formation was 33%. On analysis of these grafts residual alpha Gal staining was present, demonstrating incomplete de-cellularisation which was proposed as a cause (34, 35).…”