Failure of glow-discharge polymerization onto woven Dacron to improve performance of hemodialysis grafts.
OBJECTIVE
The ideal conduit for hemodialysis vascular access remains elusive. Autogenous fistulas and prosthetic grafts, most commonly expanded polytetrafluoroethylene (e-PTFE), have adequate long-term patency rates (60% to 80% at 1 year); however, considerable delay in their use (2 to 6 weeks) is required. The Plasma-TFE graft is a recently introduced thin-walled woven Dacron graft to which an ultrathin layer of tetrafluoroethylene is bonded through a process of glow-discharge polymerization. This process purportedly results in a graft with an internal surface of low thrombogenicity. Low thrombogenicity, combined with the healing characteristics of a woven graft, have led to claims of equivalent patency rates even when used for dialysis immediately (within 1 week) after implantation.


METHODS
This concept led us to use this new graft material in 19 fistulas (12 forearm and 7 arm) during a 1-year period.


RESULTS
Although early use was possible, the primary and secondary patency rate at 12 months was only 47.4%. Ten grafts required replacement, five within the first month and two in the second month. Attempts at fistula revision failed because of unsuccessful graft thrombectomy or exuberant intimal hyperplasia. Failure was not associated with early use. During the same time period, 28 PTFE grafts were implanted, with only four failures (primary patency 78.6%; secondary patency 85.7%; p = 0.028). The secondary patency rate was the same for Plasma-TFE grafts (47%) but improved to 85.7% for e-PTFE grafts (p = 0.005). Both groups were comparable with respect to age, diabetes, previous dialysis access procedures, and other comorbid conditions.


CONCLUSIONS
These early results have been sufficiently disappointing that we have abandoned use of this graft approved for hemodialysis by the Food and Drug Administration and cannot recommend it for other clinical indications. Nevertheless, the concept of plasma-discharge polymerization is theoretically attractive and might be useful in future graft configurations.
Farmer
D L
DL
Department of Surgery, University of California, San Francisco 94143-0222.
Goldstone
J
J
Lim
R C
RC
Reilly
L M
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004563:Electrochemistry; D004867:Equipment Design; D005260:Female; D005466:Fluorocarbons / Q000737:chemistry*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000737:chemistry*; D011108:Polymers / Q000737:chemistry; D011138:Polytetrafluoroethylene / Q000737:chemistry; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D013499:Surface Properties; D013997:Time Factors; D014654:Vascular Patency
D005466:Fluorocarbons; D011093:Polyethylene Terephthalates; D011108:Polymers; D011138:Polytetrafluoroethylene; C015531:tetrafluoroethylene