High incidence of perigraft seroma formation with gelatin-coated polytetrafluoroethylene grafts

We reviewed the effectiveness of a gelatin-coated polytetrafluoroethylene (PTFE) graft designed to reduce suture line bleeding and graft weeping. Twenty-nine adults with end-stage renal disease underwent implantation the graft (n = 30) in the arm. All had preoperative ultrasound vascular mapping to assess their options for an autogenous arteriovenous fistula and patients with a history of prior central venous devices or sternotomy underwent contrast venography. A 4- to 7-mm tapered graft (n = 10) was used if the inflow artery was <4.0 mm in diameter, and a 6-mm straight graft (n = 20) was used if the artery was ≥4.0 mm. Intraoperative volume flows were measured by duplex methodology. Precautions to prevent ultrafiltration and seroma development were taken. Eleven clinically significant seromas were detected in 30 sealed PTFE grafts (36.7%), 10 in the 6-mm grafts (50%), and 1 in a 4- to 7-mm graft (10%), a significant difference between graft types. There were no significant differences in flow between the graft types and between grafts with seromas versus no seromas. Five grafts were explanted and one was ligated, resulting in cannulation delays from 2 to 4 months. We conclude that the gelatin-sealed PTFE vascular graft is not the ideal prosthesis for hemodialysis access.