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Comparison of survival of an expanded polytetrafluoroethylene graft designed for early cannulation to standard wall polytetrafluoroethylene grafts.

Abstract

BACKGROUND
Placement and maintenance of a well-functioning vascular access are essential for delivery of adequate hemodialysis. Newly placed polytetrafluoroethylene (PTFE) arteriovenous grafts require a period of wound healing and incorporation of fibrous tissue before use, a period typically lasting two to three weeks. An ideal PTFE graft would be one that can be used for vascular access immediately, obviating the need for temporary dialysis catheters. Recently an expanded PTFE (ePTFE) graft with a mesh cannulation segment (Diastat graft) has been proposed for early cannulation.
STUDY DESIGN
This is a retrospective single-center study comparing ePTFE graft survival to contemporaneously placed standard wall PTFE (GORE-TEX) grafts.
RESULTS
Forty-seven consecutive new or established patients receiving chronic hemodialysis had grafts (25 ePTFE, 22 standard PTFE) placed between November 1994 and July 1995. There were no significant differences between the groups in age, race, gender, incidence of diabetes mellitus, or peripheral vascular disease. By the end of the study, 21 of 25 ePTFE grafts had clotted, compared with 11 of the 22 patients receiving a standard PTFE graft. Median time to first clotting was 53 days for the ePTFE grafts and 164 days for the standard PTFE grafts (p < 0.0001). Nine patients with ePTFE grafts required a temporary catheter after their first clotting episode.
CONCLUSIONS
The ePTFE grafts thrombosed at a significantly higher rate than standard wall PTFE grafts. Further experience with the Diastat graft might improve graft survival. However, early experience does not suggest that the avoidance of short-term temporary access outweighs the problem of high clotting rate, and its attendant morbidity.

Authors

Coyne DW, Lowell JA, Windus DW, Delmez JA, Shenoy S, Audrain J, Howard TK

Source

Journal of the American College of Surgeons 183:4 1996 Oct pg 401-5

MeSH

Arteriovenous Shunt, Surgical
Blood Vessel Prosthesis
Brachial Artery
Catheters, Indwelling
Female
Forearm
Graft Occlusion, Vascular
Graft Survival
Humans
Life Tables
Male
Middle Aged
Polytetrafluoroethylene
Prosthesis Design
Renal Dialysis
Retrospective Studies
Time Factors
Veins

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8843271