Recently, a patient asked at a follow-up visit about vessel reconstruction with bovine pericardium. A foreign case study published last year in the journal Kidney and Dialysis described using a biological material, bovine pericardium (xenograft/heterograft: a biological vascular graft), to rebuild a dialysis patient’s lifeline.
When the “lifeline” sounds a warning
This is a real medical case of a 44-year-old man who had been on dialysis for a year because of end-stage kidney disease. During preparation for one dialysis session, the staff noticed that his fistula had no thrill (vibration) and no pulsation.
Ultrasound showed that the vessel in his arm had not only swollen into a large “balloon” (an aneurysmal dilation) but had also formed a clot inside, completely blocking the dialysis access. If the segment could not be repaired, a new access might have to be created surgically at another site, a heavy physical and psychological burden for the patient.
Reconstruction with a biological bovine pericardial graft
In this situation, conventional treatment could include replacing the segment with a synthetic graft, or harvesting a vein from the patient’s leg for repair and reconstruction. Here, a medical team in Romania reconstructed it with a biological material, bovine pericardium (xenograft/heterograft: a biological vascular graft).
- Material: a “biological bovine pericardium” patch was selected.
- Rolling and suturing: on the operating table, the surgeon used a medical catheter (chest tube) of the right diameter as a mold, shaped the patch into the desired vessel form, and stitched it with fine sutures into a “biological small pipe.”
- Anastomosis: the surgeon removed the damaged aneurysmal segment of the arm vessel and precisely sutured this custom “bovine pericardial conduit” back in.
Images adapted from the reference: Reconstruction of a Thrombosed Aneurysmal Radio-Cephalic Arteriovenous Fistula with a Tubular Bovine Pericardial Conduit Kidney Dial. 2025, 5(3), 46
Images adapted from the reference: Reconstruction of a Thrombosed Aneurysmal Radio-Cephalic Arteriovenous Fistula with a Tubular Bovine Pericardial Conduit Kidney Dial. 2025, 5(3), 46
Result
The operation was successful. The moment the vascular clamp was released, blood flowed again. Ultrasound showed a blood flow of 651 mL/min. At one-month follow-up there was no sign of rejection, infection or re-narrowing of this biological conduit. This case offers another feasible option for vessel repair.
A reminder: in Taiwan, under the National Health Insurance Administration’s rules for special materials, bovine pericardium patches are mainly reimbursed for complex congenital heart surgery or aortic and pulmonary artery reconstruction. Routine dialysis access reconstruction often does not meet these criteria.
This content is for sharing medical knowledge only. Every patient’s vessels are different; if you have a related medical need, please consult a professional vascular surgeon to make the plan best suited to you.
Link to the original article Kidney Dial. 2025, 5(3), 46 (open access)
