A COMPARISON BETWEEN PTFE AND DENATURED HOMOLOGOUS VEIN GRAFTS FOR HEMODIALYSIS ACCESS - A PROSPECTIVE RANDOMIZED MULTICENTER TRIAL

Objectives: To compare patency and complication rates of polytetrafluo roethylene (PTFE) grafts and denatured homologous vein (DHV) grafts fo r long-term haemodialysis. Design: A prospective randomised multicentr e trial. Materials: One hundred and thirty-one patients were enrolled between September 1994 and April 1997. Sixty-three DHV grafts and 68 P TFE grafts were implanted in 60 males and 71 females. Complications an d interventions were monitored. Patency rates, complication rates, and intervention rates of PTFE and DHV were compared. Results: The mean f ollow-up was 313 days for DHV (range 1-771) and 339 (3-909) days for P TFE. The total follow-up was 54.1 patient-years for DHV and 63.1 for P TFE. The 1-year primary patency rates were 30% and 40% for DHV and PTF E respectively. Secondary patency rate was 63% for both DHV and PTFE. Most frequent complication was thrombosis. A total of 75 thrombotic ev ents (1.39 per patient-year) occurred in 35 (56%) DHV grafts and 78 (1 .24 per py) in 36 (53%) PTFE grafts. A total of nine infections were s een in nine (14%) DHV grafts, whereas 21 infections in 20 (29%) PTFE g rafts were seen (p=0.08). All but one infected DHV graft could be salv aged with systemic antibiotics. In contrast, surgical intervention was necessary in nine PTFE grafts (p=0.02). For aneurysms, eight DHV and two PTFE grafts needed revision (p=0.03). Conclusion: Patency rates be tween DHV and PTFE were not different. More infections were seen in PT FE grafts, and significantly more PTFE grafts needed surgical revision or removal because of infection. Significantly more DHV grafts were s urgically revised or removed because of aneurysms.