Interposition graft fistulas for hemodialysis

Area of Science:

• Vascular Surgery
• Nephrology
• Biomaterials

Background:

• Radiocephalic arteriovenous (AV) fistulas are the preferred vascular access for hemodialysis.
• When radiocephalic AV fistulas are not feasible, interposition AV fistulas using synthetic grafts serve as an alternative.
• Synthetic grafts, including polytetrafluoroethylene (PTFE) and bovine grafts, are utilized for interposition AV fistulas.

Purpose of the Study:

• To review the experience with interposition AV fistulas using synthetic grafts.
• To evaluate the patency rates and complications associated with interposition graft fistulas.
• To determine the need for additional surgery in patients with interposition graft fistulas.

Main Methods:

• A review of 49 interposition grafts (41 patients) placed in the forearm.
• Grafts included 40 polytetrafluoroethylene (PTFE) and nine bovine grafts.
• Grafts were placed either as straight conduits or as loops connecting arterial and venous vessels.

Main Results:

• At a mean follow-up of 13 months, nine grafts remained in use and nine failed.
• Reoperation was required in 30 instances due to complications, successfully resuming dialysis in 25 cases.
• Reoperation was significantly more common in straight grafts compared to loop grafts (p < 0.01).

Conclusions:

• Interposition AV fistulas using synthetic grafts are a viable second-line option for hemodialysis vascular access.
• Loop configuration of interposition grafts is associated with better outcomes and fewer complications than straight configurations.
• PTFE loop graft fistulas are recommended as the second choice for angioaccess after radiocephalic fistulas.