Experience with dacron graft arteriovenous fistulas for dialysis access.
The technique, hemodynamics, and results of a new, more successful Filamentous Velour Dacron graft dialysis fistula between brachial artery and axillary vein are described. Hemodialysis has been successfully instituted in 15/16 patients. One graft was removed for infection and one for overlying skin erosion. There have been five episodes of thrombosis, all with successful restoration to function. After a median nine-month follow-up, nine of 16 grafts have been complication-free and 13 of 16 remain functional or functioned until the time of death. Hemodynamic studies revealed that with high flows (even 1900 cc/min), there was no evidence of cardiac failure or peripheral "steal". One patient with low flow (less than 300 cc/min) had transient distal ischemic symptoms and another with similar flow later developed arterial occlusion distal to the fistula after suffering a myocardial infarction. With increased attention to technical details observed in this early experience, it appears that greater than 80% of these grafts should provide long-term dialysis access for this difficult patient population.
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation / Q000379:methods*; D001367:Axillary Vein / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D001916:Brachial Artery / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000379:methods*; D013927:Thrombosis / Q000209:etiology
D011093:Polyethylene Terephthalates