[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.
Utzig
M J
MJ
Abteilung für Allgemein-, Gefäss- und Thoraxchirurgie, Chirurgische Klinik und Poliklinik I, Universitätsklinikum Benjamin Franklin, Berlin. martin.utzig@ukbf.fu-berlin.de
Foitzik
Th
T
Dollinger
P
P
Buhr
H-J
HJ
D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies
D011138:Polytetrafluoroethylene