ALLOPLASTIC VASCULAR ACCESS IN HEMODIALYS IS

A direct arteriovenous fistula provides the most durable access site f or hemodialysis with excellent long-term patency and a low infection r ate. Once the sites for a direct arteriovenous (av) fistula in the upp er extremity have been exhausted, a prosthetic bridge graft is often r equired. initially in the upper arm. When this option is no longer fea sible we often resort to an allograft loop in the forearm or the lower extremity. In total 182 PTFE-shunts (116 brachiosubclavian bridge gra ft fistulas. 45 loopgrafts in the lower extremity and 21 loop-grafts i n the forearm) were created in 146 patients, constituting 15,7% of all av-fistulas created at the Department of Vascular Surgery Karl Franze ns University Graz, Austria in a period of 6 years. The patency rate w as calculated by means of the actuarial or life-table method, which ac counts for differing lengths of follow-up in the grafts. The overall p atency rates, including thrombectomy and revision were 77,5% in brachi osubclavian shunts, 69,4% in lower extremity loop-grafts and 65,1% in forearm loop-grafts after 24 months. The average number of revision an d/or thrombectomy procedures performed for each upper arm bridge graft was 0.43, for loops in lower extremity 0.69 and for loops in the fore arm 0,71. The types of operations performed to keep the grafts patient included: thrombectomy n = 44. repair of aneurysms n = 16, patch angi oplasty n = 14, percutaneous intraluminal angioplasty n = 12. Evacuati on of hematoma and infections treated with nonsurgical measures were n ot included. Removal of the graft because of deep infections were nece ssary in 9 cases. Distal ischemia in lower extremity required shunt li gation in 1 patient.