MEDIUM-TERM FOLLOW-UP OF 40 AUTOGENOUS VEIN AND 40 POLYTETRAFLUOROETHYLENE (GORE-TEX) GRAFTS FOR VASCULAR ACCESS

Abstract

Patency of 40 polytetrafluoroethylene (PTFE) and 40 autogenous vein arteriovenous grafts for vascular access among 56 patients is compared. Most patients required access for hemodialysis, but 6 grafts were for other reasons including hyperalimentation and drug administration. Cumulative patency at 3 yr for PTFE grafts and vein grafts was 64%. The complication rate necessitating secondary operation was > 3 times greater in the PTFE group in which 35 secondary procedures were needed. No grafts became infected as a result of the initial operation, but 8 serious complications were associated with subsequent infection of PTFE grafts and 3 with vein grafts including postcannulation bleeding, abscess and aneurysm. PTFE grafts (26) developed associated stenosis in the runoff vein. This was demonstrated with angiography in 10 and the stenoses were excised and grafted, 1 being dilated by intravascular balloon. In 16 thrombosis was the 1st indication of stenosis. Histologically narrowed runoff veins showed intimal hyperplasia. Runoff stenosis did not occur among vein grafts, but in 8 vein grafts themselves became stenotic. Due to a higher complication rate with PTFE grafts, vein grafts should be used when possible.