title: A single center experience in the use of polyurethaneurea arteriovenous grafts.
abstract: 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.
authors.affiliation: Department of Nephrology and Hypertension, St. John Hospital and Medical Center, Detroit, Michigan, USA.
authors.forename: Dijana
authors.initials: D
authors.lastname: Jefic
authors.forename: Pritham P
authors.initials: PP
authors.lastname: Reddy
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Flynn
authors.forename: Robert
authors.initials: R
authors.lastname: Provenzano
mesh_terms: 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
chemical_list: D011140:Polyurethanes