ABSTRACT
HISTORICAL PERSPECTIVE The development of the first chronic arteriovenous (AV) fistula is attributed to Scribner and colleagues, who described the use of a polymer-based shunt (1). This shunt was established outside the body and provided access to the bloodstream. Initial work with this device was designed to evaluate the feasibility of establishing a long-term vascular access based on polymer implants (2,3). The use of an external shunt permitted vascular access but was problematic for several reasons, including, initially, the development of infection at the polymer-subcutaneous tissue interface, thrombosis within the graft, lack of control of bleeding at puncture sites, and the development of anastomotic complications related to polymer-tissue interactions (4,5). While these initial results were not optimal, they were encouraging enough to prompt a search for other materials suitable for access construction. Two basic material groups were subsequently evaluated: synthetic polymer-based materials and grafts made of natural materials. The selection, use, and clinical outcome of all these materials is based primarily on the lack of suitable vessels available for construction of an autogenous fistula, which
has remained the ‘‘gold standard’’ for vascular access since its introduction by Brescia et al. 30 years ago (6).
