Long-term patency rates, complications and cost-effectiveness of polytetrafluoroethylene (PTFE) grafts for hemodialysis access: a prospective study that compares Impra versus Gore-tex grafts

Manufacturers of polytetraflouroethylene (PTFE) grafts used for chronic hem odialysis access describe specific advantages for their respective grafts, which presumably result in greater graft patency rates, reduced complicatio ns and decreased overall costs. There are few data available in the literat ure to support or contradict these alleged benefits. Therefore, this prospe ctive study was undertaken to evaluate and compare patency rates, complicat ions and costs between two of the leading brands of PTFE that are currently being marketed for use as hemodialysis access grafts. Totals of 190 primar y PTFE grafts (100 Gore-tex (W. L. Gore and Associates, Flagstaff, AZ) and 90 Impra (C. R. Bard Inc., Tempe, AZ)) were implanted in 168 consecutive pa tients with end-stage renal disease. A policy of non-interventions was empl oyed for patent grafts, as no attempt was made to assist primary patency, G rafts that occluded during follow-up underwent secondary revision to mainta in patency, There was no difference in primary and secondary patency by lif e-table analysis between Gore-tex and impra grafts at 2 years (P > 0.53 and P > 0.13, respectively). There was also no significant difference between Gore-tex and Impra in the number of days before the first thrombectomy or i n the number of thrombectomies or revisions per graft (P > 0.50). Likewise, the incidence of complications was similar between the two grafts, The cos t of graft implantation and maintenance of patency was not significantly di fferent between Gore-tex and Impra grafts. it is concluded that either graf t can be used for hemodialysis access with similar expected outcomes for at least 2 years following implantation. (C) 1998 The International Society f or Cardiovascular Surgery, Published by Elsevier Science Ltd. All rights re served.