Related Experiment Videos
Early experience with a new ePTFE vascular prosthesis for hemodialysis
S T Bartlett1, E J Schweitzer, J E Roberts
1Department of Surgery, University of Maryland Medical Center, Baltimore, USA.
Background:
An expanded polytetrafluoroethylene (ePTFE) graft for hemodialysis designed for immediate cannulation was tested. The graft contains a cannulation segment consisting of a stretch ePTFE base tube surrounded by flat and round ePTFE fibers that are secured by a thin, perforated ePTFE cover. This study reports our early experience with this new vascular prosthesis.
Patients And Methods:
Between June 1994 and March 1995, 48 arteriovenous grafts were implanted in 47 patients for whom autogenous fistula construction was impossible. Mean patient age was 57 years (range 37 to 85), 86% of the patients were black, and 60% were men. Twenty-two (46%) grafts were in the forearm, 19 (39%) in the upper arm, and 7 (15%) in the groin. Unassisted and assisted patency rates were calculated by the Kaplan-Meier method. The times of first hemodialysis relative to implantation and the times to hemostasis after first decannulation were recorded. Explanted grafts were histologically evaluated with hematoxylin and eosin and Gram's stains.
Results:
The unassisted and assisted 6-month patency rate were 42% and 73%, respectively. Five of the first 10 graft were lost to management and technical errors, after which the respective patency rates were 56% and 82%. Eleven of 22 thrombosed grafts were salvaged, 9 with urokinase thrombolysis and 2 with surgical thrombectomy. Twenty-eight grafts were cannulated within 7 days. The time to hemostasis was usually 2 to 4 minutes and always less than 15 minutes. Histologic analysis of a graft explanted at 40 days showed good fibrous incorporation and capillary ingrowth between the cover and round fibers.
Conclusions:
This new ePTFE vascular prosthesis can be safely cannulated immediately after implantation, avoiding the morbidity of temporary central venous catheter hemodialysis. After an initial period of familiarization, patency similar to that of other ePTFE arteriovenous grafts was achieved. For patients requiring urgent hemodialysis, this graft is an ideal alternative that allows immediate, safe cannulation.