FAILURE OF GLOW-DISCHARGE POLYMERIZATION ONTO WOVEN DACRON TO IMPROVEPERFORMANCE OF HEMODIALYSIS GRAFTS

Purpose: The ideal conduit for hemodialysis vascular access remains el usive. Autogenous fistulas and prosthetic grafts, most commonly expand ed polytetrafluoroethylene (e-PTFE), have adequate long-term patency r ates (60% to 80% at 1 year); however, considerable delay in their use (2 to 6 weeks) is required. The Plasma-TFE graft is a recently introdu ced thin-walled woven Dacron graft to which an ultrathin layer of tetr afluoroethylene is bonded through a process of glow-discharge polymeri zation. This process purportedly results in a graft with an internal s urface of low thrombogenicity. Low thrombogenicity, combined with the healing characteristics of a woven graft, have led to claims of equiva lent patency rates even when used for dialysis immediately (within 1 w eek) after implantation. Methods: This concept led us to use this new graft material in 19 fistulas (12 forearm and 7 arm) during a 1-year p eriod. Results. Although early use was possible, the primary and secon dary patency rate at 12 months was only 47.4%. Ten grafts required rep lacement, five within the first month and two in the second month. Att empts at fistula revision failed because of unsuccessful graft thrombe ctomy or exuberant intimal hyperplasia. Failure was not associated wit h early use. During the same time period, 28 PTFE grafts were implante d, with only four failures (primary patency 78.6%; secondary patency 8 5.7%; p = 0.028). The secondary patency rate was the same for Plasma-T FE grafts (47%) but improved to 85.7% for e-PTFE grafts (p = 0.005). B oth groups were comparable with respect to age, diabetes, previous dia lysis access procedures, and other comorbid conditions. Conclusions: T hese early results have been sufficiently disappointing that we have a bandoned use of this graft approved for hemodialysis by the Food and D rug Administration and cannot recommend it for other clinical indicati ons. Nevertheless, the concept of plasma-discharge polymerization is t heoretically attractive and might be useful in future graft configurat ions.