Patency of surgically revised ePTFE-dialysis access grafts

Native av-fistulas are the access of first choice for long-term hemodialysis. However, a large number of patients require an alternative vascular access, e. g. ePTFE grafts. Patency of ePTFE grafts is inferior to that of native av-fistulas.

Objective: To analyse the effectiveness of surgical revisions of occluded straight ePTFE dialysis access grafts.

Methods: Retrospective review of all upper arm dialysis access procedures from 1/94 to 8/99.

Results: Redo surgery was performed in 67 patients. Av-fistula dysfunction was caused by venous anastomotic stenoses (22 %), outflow occlusion (9 %), arterial anastomotic stenoses/inflow occlusion (12 %), and intragraft stenoses (6 %). 9 grafts had to be revised due to infection or perigraft hematoma (14 %). In 37 % the cause of graft occlusion could not be identified. Neither the cause of occlusion nor the type of treatment correlated with patency after revision. 6- and 12-months primary patency after surgery were 29 % and 11 %. 59 shunts required up to 12 revisions to maintain patency. Thus, secondary 1 yr-patency after revision was 29 %.

Conclusions: Patency after redo surgery is disappointing. However, with repeated procedures ePTFE grafts remain open > 1 year in 29 % of the patients.