A SURVEY OF VASCULAR ACCESS FOR HEMODIALYSIS

To analyze the current status of various techniques for vascular acces s in patients with chronic renal failure requiring hemodialysis, a ret rospective review of 113 patients over a period of nineteen years unde rgoing either radiocephalic (direct) shunts or polytetrafluoroethylene (PTFE) shunts was conducted. Accessibility rate was determined as tot al time of graft function until ultimate failure. Direct shunt was und ergone by 93 patients (82%). Accessibility was 89% and 80% at one and five years, respectively. Twenty patients (18%) underwent PTFE shunts. Accessibility was 61% and 29% at one and five years, respectively. Th rombosis, which was the main complication accounting for graft failure , occurred earlier and more frequently in the PTFE group. Results in p atients with diabetes mellitus (DM) were also significantly worse. A d irect shunt at the most peripheral site is the most favorable option f or vascular access for hemodialysis. Because of poorer results with PT FE, more proximal native vessels (ie, brachial artery to antecubital v ein) are preferable if distal shunts are not possible.