Clinical application of a self-sealing poly(ether-urethane) graft applicable to blood access for hemodialysis

A poly(ether-urethane) graft (PEU) has been developed by our group and examined clinically. From July 1986, four straight and 11 loop grafts were implanted in 15 patients on maintenance hemodialysis. One straight and three loop grafts thrombosed between 1-6 months after the operation. One loop graft was ligated to remedy edema caused by a preexisting subclavian vein thrombosis. Angiographic findings of the grafts revealed a smooth positioning of the graft in most of the cases with minimal to moderate stenosis at anastomotic sites. Punctured sites were identified as tiny filling defects on the wall. However, neither stenosis nor aneurysmal dilatation were observed. Specimens of the graft were obtained from three patients to examine histological findings. Neointimal coverage was observed near the anastomotic site in a specimen obtained 6 months after the operation. The bare luminal surface still remained at the center of the graft. No clinical sign of peripheral thrombi was found. In addition to the clinical experience, this study is supplemented with the preliminary result of an animal experiment using a newly modified PEU graft with an open structure on the luminal surface.