Adenovirus Vascular Endothelial Growth Factor (VEGF) Therapy in Vascular Access - Novel Trinam AGainst Control Evidence

Inclusion Criteria: * Patients with end stage renal disease undergoing either initial placement or replacement (after failure of previous vascular access) of an end-to-side or end-to-end 6.0 mm synthetic PTFE arteriovenous hemodialysis access arm graft. * Male or female aged 18 years or over. * Patients who signed the informed consent form. * Patients who are expected to undergo dialysis at nominated facilities for the duration of the study. * Patients who have agreed to participate in the additional four year gene therapy safety monitoring. * Patients who are willing to agree they will not have a kidney transplant for four weeks post treatment with Trinam®. * Patients who have undergone arterial and venous mapping to ensure an adequate and appropriate access site is available for placement of either an end-to-side or an end-to-end 6.0 mm synthetic PTFE arteriovenous hemodialysis access arm graft with or without the addition of Trinam®. Exclusion Criteria: * Patients who are unable to understand and sign the consent form. * Patients undergoing surgical revision of an existing graft. * Exclude patients from the study if they have moderate or severe macular edema moderate or severe proliferative diabetic retinopathy * Current diagnosis of cancer with exception of non-melanoma skin cancers. * Hepatic dysfunction defined as AST and / or ALT \> 2 times the Upper Limit of Normal. * Diabetic patients with Hemoglobin A1C value of \>10%. * White blood cell (WBC) count \< 2.0 x 109/L. * Prior anticoagulant therapy within 14 days prior to surgery is an exclusion. * Known sensitivity to collagen. * Pregnancy, lactation or lack of effective contraception both in women and in men of childbearing potential. * Previous participation in any Trinam® study. * Receipt of any investigational drug within 30 days prior to study enrollment or participation in any concurrently running trial involving investigational intervention. * Any medical or psychiatric condition that compromises the ability to participate in the study. * Known or suspected drug or alcohol abuse in the past six months. * Life expectancy of less than one year. * Known immunodeficiency disease. * Known chronic hepatitis of viral or non-viral etiology and / or a history of decompensated liver failure of any etiology.