Difficult vascular access in patients with end-stage renal failure

Area of Science:

• Nephrology
• Vascular Surgery
• Medical Devices

Background:

• End-stage renal disease (ESRD) necessitates durable vascular access for chronic hemodialysis.
• Arteriovenous fistulas (AVFs) are the preferred initial vascular access due to high patency and low complication rates.
• Arteriovenous grafts (AVGs) using expanded polytetrafluoroethylene (ePTFE) serve as an alternative when AVF creation is not feasible.

Purpose of the Study:

• To review the clinical experience with ePTFE AVGs for vascular access in patients undergoing chronic hemodialysis.
• To evaluate the patency rates and complication profile of ePTFE AVGs.

Main Methods:

• A prospective study involving 21 patients who received ePTFE AVGs between September 2002 and October 2004.
• Evaluation of graft complications and patency over a 24-month period.

Main Results:

• The study included 21 patients (12 female, 9 male) with a mean age of 58 years.
• The 24-month patency rate for ePTFE AVGs was 85.7%.
• Complications observed included graft thrombosis (14.3%), wound infection (14.3%), and graft infection (4.8%).

Conclusions:

• ePTFE AVGs demonstrate acceptable patency and serviceability for hemodialysis vascular access.
• The complication profile of ePTFE AVGs suggests that native vein AVFs should remain the primary choice for vascular access.
• Careful patient selection and monitoring are crucial for managing AVG-related complications.