Bilateral carotid‐jugular arteriovenous graft implantation in an ovine model is safe and durable for facilitation of arteriovenous graft innovation

Over 550 000 people in the U.S. require hemodialysis for management of end stage renal disease (ESRD). When anatomy restricts fistula creation, arteriovenous grafts (AVG) are implanted. AVGs have poor primary patency and high risk of infection, highlighting a need for better alternatives. Previous AVG large animal models were limited by high complication rates and short-term follow-up. This study investigates the safety and durability of an ovine bilateral carotid-jugular AVG model. Eight female sheep underwent bilateral carotid-jugular AVG implantation via a single longitudinal incision overlying the trachea. Ringed PTFE grafts were anastomosed in a "lazy-S" configuration to provide the laxity needed to prevent avulsion and minimize kinking with neck movement. Post-operatively, sheep were evaluated daily to monitor for complications. Duplex ultrasonography of the grafts was performed at regular intervals out to 6 months to evaluate patency. At 6 months, angiography and duplex was performed followed by explant for gross and histologic analysis. Technical success was achieved in 16 of 16 (100%) graft implants. No major complications, including stroke, anastomotic disruption, infection, wound breakdown, or death occurred. Primary patency of control PTFE grafts was 75% at 6 months, paralleling reported rates in humans. Bilateral carotid-jugular AVG implantation in sheep is a safe and durable model for self-controlled long-term evaluation of AVG conduit technology.