EARLY EXPERIENCES WITH A MODIFIED STRETCH POLYTETRAFLUOROETHYLENE GRAFT FOR HEMODIALYSIS ACCESS SURGERY

The implantation of alloplastic vascular grafts as access for chronic hemodialysis is unavoidable in patients for whom autogenous fistula co nstruction was impossible. There are numerous disadvantages associated with vascular prosthesis for hemodialysis such as bleeding at the pun cture site and graft infection. An expanded polytetrafluoroethylene (e PTFE) graft (Diastat, W.L. Gore and Associates Ges.m.b.H.) designed fo r hemodialysis improved our results especially in the early postoperat ive period. The graft contains a cannulation segment consisting of a b ase stretch-ePTFE-tube surrounded by flat and round ePTFE-fibers that are secured by a thin, perforated ePTFE-cover. For patients requiring urgent hemodialysis, this prosthesis can be safely cannulated immediat ely after implantation, avoiding the morbidity of temporary central ve nous catheter hemodialysis. The highly porous surface of the prosthesi s leads to improved graft healing with cellular ingrowth from the adve ntitial layer. This fact could be associated with an increased infecti on resistance of these grafts. This study reports our early experience with this new vascular prosthesis in 20 brachiosubclavian bridge graf t fistulas, The incidence of puncture complications, perigraft seroma and thrombosis was insignificant in spite of immediate cannulation. Th e unassisted and assisted 12-month patency rates were 80% and 95%.