What is your opinion, or what is known about buttonhole in either bovine or impra grafts?
I am not aware of any published data on the use of buttonhole with bovine grafts. The use with PTFE has been avoided and not recommended because of the concern about establishing a permanent track to and through the graft where only a clot plugs the hole after cannulation which could likely blow out and result in hemorrhage. Studies need to be done on this with synthetic grafts, but I would not recommend being the first on the block to try this, considering the potential life-threatening consequences. Finally, I would also hold off on bovine or other biologic graft materials for now, since when these grafts are treated, sterilized and then used for cannulation, they have a history of disrupting and especially of getting infected and having to be removed. Since same-site cannulation involves some degree of contamination with the scab that forms each time that has to be removed, the risk of infection is significant for a graft, whether PTFE or bovine, but especially bovine. As you know,
I am not aware of any published data on the use of buttonhole with bovine grafts. The use with PTFE has been avoided and not recommended because of the concern about establishing a permanent track to and through the graft where only a clot plugs the hole after cannulation – which could likely blow out and result in hemorrhage. Studies need to be done on this with synthetic grafts, but I would not recommend being the first on the block to try this, considering the potential life-threatening consequences. Finally, I would also hold off on bovine or other biologic graft materials for now, since when these grafts are treated, sterilized and then used for cannulation, they have a history of disrupting and especially of getting infected and having to be removed. Since same-site cannulation involves some degree of contamination with the scab that forms each time that has to be removed, the risk of infection is significant for a graft, whether PTFE or bovine, but especially bovine. As you know
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