A single center experience in the use of polyurethaneurea arteriovenous grafts.
BACKGROUND
Polytetrafluoroethylene (PTFE) grafts often require temporary catheters, which increase costs as well as risk of infection, bleeding, and poor blood flow. Polyurethaneurea (PUU) grafts can be cannulated within 24 hours of placement, avoiding the need for temporary catheters.


METHODS
Hemodialysis patients who were not candidates for arteriovenous fistula (AVF) were eligible for the study. Those requiring urgent (<48 hours) hemodialysis access received PUU grafts; all others received PTFE grafts. One surgeon performed all implantations.


RESULTS
133 PUU grafts were implanted, 31 (24%) patients died (unrelated to graft placement). Within the first 4 days after graft placement, 108 of 133 grafts (81%) were cannulated. None required a temporary catheter. Of 102 surviving patients, 50 (49%) had graft thrombosis; 47/50 (94%) underwent successful percutaneous thrombectomy (PT). Primary patency at 6 months and at 1 year was 51% and 33%, respectively. Secondary patency at 6 months and 1 year was 78% and 61%, respectively. Mean bleeding time (after withdrawal of dialysis needle) was 4.0 (range 1-14) minutes in PUU grafts vs. 9.2 (1-30) minutes in PTFE grafts.


CONCLUSIONS
Polyurethane graft placement allowed early graft cannulation without temporary catheters. Patency rates are comparable with previous reports. Decreased bleeding time with PUU grafts reduced aggregate blood exposure for patients and staff, lowering the risk of infection and anemia exacerbation and speeding time between treatments.
Jefic
Dijana
D
Department of Nephrology and Hypertension, St. John Hospital and Medical Center, Detroit, Michigan, USA.
Reddy
Pritham P
PP
Flynn
Lisa M
LM
Provenzano
Robert
R
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011140:Polyurethanes; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D011140:Polyurethanes