Effects of a venous cuff at the venous anastomosis of polytetrafluoroethylene grafts for hemodialysis vascular access

Introduction and Methods: The most frequent complication of polytetrafluoro ethylene (PTFE) arteriovenous gafts for hemodialysis is thrombotic occlusio n due to stenosis caused by intimal hyperplasia. This complication is also known for peripheral bypass grafts. Because the use of a venous cuff at the distal anastomosis improves the patency of peripheral bypass grafts, we co nsidered that it might also improve the patency of PTFE arteriovenous graft s. Therefore, a randomized multicenter trial was carried out to study the e ffect of a venous cuff at the venous anastomosis of PTFE arteriovenous graf ts on the development of stenoses and the patency rates. Results: Of the 120 included patients, 59 were randomized for a venous cuff . The incidence of thrombotic occlusion was lower in the cuff group (0.68 p er patient-year) than in the no-cuff group (0.88 per patient-year; P = .000 7). However, the primary and secondary patency rates were comparable. The c uff group tended to have fewer stenoses at the venous and arterial anastomo ses when examined with duplex scan. Graft failure was higher in patients wi th an initial anastomosing vein diameter smaller than 4 mm (7 of 18 [39%]) than in those with a vein diameter of 4 mm or larger (16 of 88 [18%]; P = . 052). Local edema, skin atrophy, and obesity yielded a higher risk on graft failure (23% vs 11%). Conclusion: A venous cuff at the venous anastomosis of PTFE arteriovenous g rafts for hemodialysis reduced: the incidence of thrombotic occlusions; ste nosis at the venous anastomosis was reduced. However, this did not result i n a better patency rate. Therefore, the venous cuff should not be used rout inely. Initial vein diameter and local problems (edema, obesity, or skin at rophy) appear to be the most important risk factors for graft failure.