Early cannulation of plasma TFE and Gore-Tex grafts for hemodialysis: a prospective randomized study

Fifty-one consecutive vascular access procedures were randomized to either the Medtronic plasma TFE or Gore-Tex polytetrafluoroethylene (PTFE) conduits in patients requiring immediate dialysis from December 1989 to April 1990. There were 49 forearm loop fistulas and 2 upper arm grafts. Fifty of these fistulas were cannulated within 48 h of placement to avoid use of subclavian venous catheters for hemodialysis. Complications related to the early cannulation of these fistulas included 2 hematomas in the plasma TFE group, and 3 hematomas in the Gore-Tex group (p = 1.00). Two patients with Gore-Tex grafts were systemically heparinized prior to hematoma formation after thrombectomy of their accesses. There were no adverse sequelae in these 5 patients, and none of the hematomas interfered with further dialytic therapy. One patient in the plasma TFE group and 3 patients in the Gore-Tex group developed cellulitis within the first month of placement (p = 0.65). All were treated with intravenous vancomycin with resolution of the erythema. None of the plasma TFE and 3 of the Gore-Tex fistulas thrombosed within 30 days of placement (p = 0.22). All were salvaged by thrombectomy. Both the plasma TFE and Gore-Tex vascular conduits may be used after surgical placement for early dialytic therapy and are associated with minimal early complications. The early use of these fistulas may eliminate the need for subclavian venous cannulation in most patients with renal failure, thus diminishing the incidence of subclavian venous stenosis and thrombosis. Further observation of these grafts will be necessary to determine the effect of immediate cannulation on their long-term performance for hemodialysis.