COMPOSITE DIALYSIS ACCESS GRAFTS

Hemodialysis access devices constructed of expanded polytetrafluoroeth ylene (ePTFE) require a maturation period of seven to 14 days before c annulation. Percutaneously placed dual-lumen catheters can be used for temporary access during this interval but are associated with signifi cant short and long term complications. Access devices constructed of Plasma-TFE(R) (pl-TFE) (Atrium, Hollis) conduits have been reported to tolerate cannulation immediately after placement, but long term paten cy is inferior to that of conventional ePTFE. To combine the immediate access advantages of pl-TFE and the long term patency of ePTFE, compo site grafts were constructed, which consisted of 10 to 12 centimeters of pl-TFE and the remainder of ePTFE. The pl-TFE segment was made avai lable for immediate access and the ePTFE segment after an appropriate maturation period. Thirty percent of composite grafts were cannulated on the day of placement and 83.8 percent were cannulated within 72 hou rs. No complications of early access of the pi-TEE segment occurred. T hese grafts were compared with a cohort of conventional ePTFE grafts f or the occurrence of thrombosis, infection and pseudoaneurysm. No sign ificant differences were noted. Event-free patency of the two groups w as equal (327.7 versus 346.3 days, p=0.282). Patency after an initial thrombotic episode was slightly better in the composite group. We conc lude that composite dialysis access grafts can be cannulated immediate ly after placement and demonstrate long term performance at least equa l to that of conventional ePTFE grafts. Use of the composite graft con cept should be considered when immediate dialysis is needed and to avo id the use of temporary access catheters.