Grafts for hemodialysis access: results and complications

Vascular access for hemodialysis has taxed the ingenuity of surgeons for a long time. Although the Brescia-Cimino arteriovenous fistula has become the principal access, usage of grafts become necessary when suitable artery and vein are not available for making a fistula. A total of 36 grafts for 24 patients were placed at the Riyadh Armed Forces Hospital between January 1988 and December 1989. Three of the grafts were autologous and 33 were synthetic. The forearm was the site of placement in 31 cases, four were placed in the thigh while one was placed in the arm. Twenty-eight complications were encountered during the follow-up period of which thrombosis was the commonest occurring in 14 instances (50%). A total of 23 secondary procedures were performed to prolong graft patency of which thrombectomy was the commonest (52.2%). Eight primary grafts had to be abandoned or replaced by secondary grafts. The overall patency for primary grafts was (87.5%) at six months, (79.1%) at one year and (70.8%) at two years.