Salvage of thrombosed polytetrafluoroethylene dialysis fistulas by interposition grafting

Expanded polytetrafluoroethylene (PTFE) grafts are widely used for access in dialysis when a direct radiocephalic fistula is not possible. These grafts frequently fail as a result of thrombosis that follows the development of stenosis at the venous anastomosis. Since 1976, the author and his colleagues have had experience with eight patients who presented with acute occlusion of expanded PTFE fistulas. All were treated by immediate thrombectomy and interposition grafting to bypass the venous stenosis. Patency was satisfactory in most cases with follow-up of 1 to 17 months. The advantages of this operation over patch angioplasty at the site of the stenosed venous anastomosis are that it is technically easier and does not require visualization of the venous anastomosis or exact knowledge of the location of the stenosis.