Lower extremity ischemia after femoral arteriovenous bovine shunts

Use of bovine carotid artery grafts for femoral arteriovenous fistulas is now an accepted method of circulatory access for patients who require chronic hemodialysis. A serious but infrequently mentioned complication of this technique is lower extremity ischemia secondary to an arterial steal phenomenon. Three cases of this syndrome are presented and specific recommendations made for preoperative and intraoperative evaluation in order to avoid this complication. A possible surgical technique for correction of this syndrome is also discussed.