DURABILITY OF EARLY PROSTHETIC DIALYSIS GRAFT CANNULATION - RESULTS OF A PROSPECTIVE, NONRANDOMIZED CLINICAL-TRIAL

Purpose: Initiation of hemodialysis frequently requires temporary cent ral venous catheterization, which leads to subsequent venous stenosis in 50% of patients. These lesions severely limit upper extremity dialy sis fistula creation. The present study was undertaken to determine wh ether early cannulation (EC) allowed omission of temporary venous cath eterization without affecting perioperative morbidity and long-term gr aft patency. Methods: Seventy-nine prosthetic grafts for hemodialysis were placed in 76 patients over a 40-month period. Patients who requir ed hemodialysis between 24 and 72 hours after surgery were assigned to EC. The remaining grafts underwent late cannulation (LC) after postop erative day 14. All grafts were constructed with a 6 mm stretch-expand ed polytetrafluoroethylene conduit in the brachial artery-to-axillary vein position. Statistical analysis of cumulative primary patency esti mates and patient survival data were determined by Kaplan-Meier analys is and log-rank test, patient variables were compared using chi(2) and Fisher's exact test, and multivariate analysis was performed using Co x's proportional hazard model. Results: Forty-eight patients underwent EC and 31 underwent LC. There were no significant differences regardi ng age (mean, 61.5 years), history of diabetes, congestive heart failu re, hematocrit level (mean, 30%), or presence of peripheral vascular d isease. Thrombosis occurred before cannulation in one of 48 ECs (2.0%) and one of 31 LCs (3.2%). There were no episodes of cannulation hemor rhage or wound infection in either group. Cumulative primary patency e stimates for EC were 0.89, 0.82, and 0.70 at 3, 6, and 12 months, resp ectively. These were not significantly different from tile LC estimate s of 0.86, 0.78 and 0.74 at 3, 6, and 12 months, respectively. Overall , patients who had a history of peripheral vascular disease had a sign ificantly decreased 12-month patency late (60% vs 74%; p = 0.05). Cent ral venous catheters were emitted in 47 of 48 EC patients. Conclusion: EC of prosthetic dialysis grafts does not increase perioperative morb idity rates or decrease 12-month cumulative primary patency rates.