title: The morbidity of secondary vascular access. A lifetime of intervention.
abstract: OBJECTIVE
  to examine the outcome and incidence of access-related procedures in patients who dialyse via PTFE secondary access grafts.
  
  
  METHODS
  retrospective case note study.
  
  
  RESULTS
  recipients of secondary access procedures face a lifetime of haemodialysis access interventions. In total, 639 access-related procedures were performed on the 72 patients studied. At the end of the study five patients were wholly reliant on central venous catheters for dialysis access. Patients with secondary access grafts have little hope of transplantation; only six of 72 patients received a transplant after a secondary access procedure.
  
  
  CONCLUSIONS
  the increasing number of patients coming to synthetic access-graft procedures and the morbidity of such procedures mean that surgeons should adopt strategies to minimise the use of grafts and limit the number of interventions performed. Careful planning will also reduce the number of central line placements and help to reduce the morbidity associated with long-term haemodialysis. Increasing resources will be required to meet the rising demand for secondary access provision.
authors.affiliation: Department of Vascular Surgery, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Ruddle
authors.forename: P A
authors.initials: PA
authors.lastname: Lear
authors.forename: D C
authors.initials: DC
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene