The Future of AV Grafts

Arteriovenous grafts (AVGs) have been utilized for over 50 years for hemodialysis access. However, one of the earliest graft concepts—the use of polytetrafluoroethylene (PTFE), in its original or expanded form—originally pioneered in the 1970s, is still the most common AVG type used for dialysis access today. Small, incremental iterations have occurred over the past half-century, but overall, minimal progress has been made in this space to date. In this chapter we review new hemodialysis graft concepts currently in pre-clinical or clinical testing. Dialysis graft technologies reviewed include those that aim to create new synthetic graft conduit materials, new bioengineered tissues, those that focus on patient safety and protection, utilization of drug coatings to address venous neointimal hyperplasia, and new, less invasive, graft delivery systems. The chapter closes with a suggestion of remaining unmet needs (even if/when the technologies described in this chapter eventually gain regulatory clearance) and a vision for dialysis graft technologies and hemodialysis access systems yet to come.