ESRD refers to complete kidney failure, when the kidneys fail to detoxify more than 20% of excess water and waste from the body. Over 3 million patients are being treated for end-stage renal disease (ESRD) worldwide. This number increases by approximately 6% each year, which is significantly higher than the population growth rate (European Renal Care Providers Association). In the U.S. alone, there are more than 700,000 people with ESRD with approximately 120,000 new cases of ESRD diagnosed annually (United States Renal Data System).
The National Kidney Foundation recommends creating a native arteriovenous fistula (AVF) in which a native artery and an adjacent vein are connected for vascular access. However, over the years, the growing numbers of fistulae have revealed the disadvantages of this method: maturation time is long (2-3 months), between 30-70% of the AVFs never reach maturity and require a second surgical intervention
Bleeding times due to cannulation are long.
An alternative solution is to implant a Central Venous Catheter (CVC), a tube inserted into a vein in the neck, chest, or leg near the groin, usually only for short-term hemodialysis. There is no maturation time as access is immediate. The growing realization that fistula outcomes are unsatisfactory and that CVCs have an unacceptably high infection rate is expected to result in an increase in the use of AV access grafts. AV access grafts are usually implanted in the forearm, the upper arm or the thigh and are becoming the preferred choice for rapid access. One end is connected to an artery and the other end to a vein. The graft is a synthetic tube and is punctured 2-3 times a week for dialysis access.
Peripheral Artery Disease (PAD) is a narrowing of the arteries other than those that supply the heart or the brain. It most commonly affects the legs. The classic symptom is leg pain when walking that resolves with rest. Up to 50% of people with PAD may have no symptoms at all. High risk factors such as smoking and diabetes contribute towards increase in incidence rate of PAD. Approximately 10 million people in the US are estimated to be affected by PAD.
Vascular bypass grafting can be performed to circumvent a diseased area of the artery. The great saphenous vein is commonly used as a conduit but if inadequate or unavailable, synthetic materials (grafts) are often used for this purpose.