By-pass to proximal vein for treatment of venous stenoses in politetrafluorethylene grafts for haemodialysis

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.