title: [Proximal vein by-pass in the treatment of venous stenosis in expanded polytetrafluoroethylene prosthesis for hemodialysis].
abstract: OBJECTIVE
  To show the long-term results of 97 politetraflouroethylene dialysis grafts submitted to a graft by-pass to treat graft-vein stenosis.
  
  
  METHODS
  Venous stenoses were studied and diagnosed by means of fistulography in cases with fistula dysfunction or during surgery for graft thrombectomy. Both early and late complication rates were studied, as well as primary and secondary patency rates.
  
  
  RESULTS
  Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropathy: 19.5%. Types of grafts in which stenoses developed: straight forearms 13; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular 4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follow-up time: 21 +/- 5 months. Late complication rate: 0.30 episodes per graft-year of follow-up. Re-stenosis rate: 0.12 graft-year of follow-up. Primary cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four years, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71% at one, two, three and four years, respectively (p < 0.0016). No differences were observed between secondary patency observed after by-pass to treat dysfunction or thrombosis (p = 0.09259).
  
  
  CONCLUSIONS
  In our experience, by-pass to proximal vein is associated with good results both at short and long term, probably because the intimal hyperplasia area is excluded and because by-pass is performed on an already dilated vein. The procedure can be performed under local anesthesia and in an outpatient basis between dialysis, with little discomfort for the patient.
authors.affiliation: Unidad de Accesos Vasculares, Hospital General Universitario Gregorio Marañón, Madrid.
authors.forename: D
authors.initials: D
authors.lastname: Vega Menéndez
authors.forename: J R
authors.initials: JR
authors.lastname: Polo Melero
authors.forename: A
authors.initials: A
authors.lastname: Flores
authors.forename: J A
authors.initials: JA
authors.lastname: Rueda
authors.forename: J A
authors.initials: JA
authors.lastname: López Baena
authors.forename: R
authors.initials: R
authors.lastname: García Pajares
authors.forename: E
authors.initials: E
authors.lastname: González Tabares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002648:Child; D003251:Constriction, Pathologic; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D006435:Renal Dialysis; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene