To the Editor. —
I read with interest the paper entitled "Vascular Access for Cancer Chemotherapy" by Lempert, Knight, and Karmody (237:1964, 1977).The procedure they describe for improving vascular access for cancer chemotherapy was first described in the Southern Medical Journal in July 1974.1 In this report, we described our experience with 26 patients in whom arteriovenous fistulas were created to improve vascular access for chemotherapy. We emphasized that the fistula should be created before the difficulties with vascular access arise. In this way a bovine graft can be avoided, and equally good, if not superior, results can be obtained with a smaller surgical procedure.In patients undergoing long-term chemotherapy with the accompanying leukopenia, the resistance to infection is almost always decreased. The magnitude of any surgical procedure in these patients should be minimized in view of the risks of sepsis, morbidity, and even mortality.