Dv. Menendez et al., By-pass to proximal vein for treatment of venous stenoses in politetrafluorethylene grafts for haemodialysis, REV CLIN ES, 200(2), 2000, pp. 64-68
Objective. To show the long-term results of 97 politetraflouroethylene dial
ysis grafts submitted to a graft by-pass to treat graft-vein stenosis.
Materials and methods. Venous stenoses were studied and diagnosed by means
of fistulography in cases with fistula dysfunction or during surgery for gr
aft thrombectomy. Both early and late complication rates wee studied, as we
ll as primary and secondary patency rates.
Results. Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropat
hy: 19.5%. Types of grafts in which stenoses developed: straight forearms 1
3; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular
4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follo
w-up time: 21+/-5 months, Late complication rate: 0.30 episodes per graft-y
ear of follow-up, Re-stenosis rate: 0.12 graft- year of follow-up, Primary
cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four yea
rs, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71%
at one, two, three and four years, respectively (p < 0.0016). No difference
s were observed between secondary patency observed after by-pass to treat d
ysfunction or thrombosis (p = 0.09259).
Discussion. In our experience, by-pass to proximal vein is associated with
good results both at short and long term, probably because the intimal hype
rplasia area is excluded and because by-pass is performed on an already dil
ated vein. The procedure can be performed under local anesthesia and in an
outpatient basis between dialysis, with little discomfort for the patient.