Repeated needle trauma to grafts used for chronic hemodialysis may result in loss of graft integrity and aneurysmal formation. The gross and scanning electron microscope observations of the virgin expanded polytetrafluoroethylene graft (ePTFE) material following repeated needle punctures are presented. Understanding how the normal structure of the ePTFE graft can be affected, particularly by larger diameter needles, underlines the effect and importance of needle puncture technique. In assuming that aneurysm related to needle punctures is the only evolutive complication of the vascular access, this analysis showed that the half life of an ePTFE prosthesis which was 6 mm in diameter and 25 cm in length was reached after about 1512 punctures using the 1.8-mm diameter hemodialysis needle, 1111 punctures with the 2.1-mm diameter needle or 784 punctures with the 2.5-mm diameter needle.
Morphological, histological, and scanning electron microscopy examinations were performed on 90 surgically excised human umbilical vein grafts. Most of the explanted grafts were removed because of thrombosis or infection and were removed typically from a patient in the mid 60s and after an average duration of implantation of 11 months. Multiple structural defects were found including deep folds, breaks on the luminal surface, and delamination. These areas as well as anastomotic sites represented potential areas for thrombotic accumulation. A higher incidence of infection was observed in grafts composed of 2 or 3 segments. Bacteria were often found in folds and could be seen invading the wall of the prosthesis. In addition, bacteremic colonization was often seen in noninfected grafts. The late aneurysmal formations were also of particular concern. The biodegradation of the wall and the disruption of the polyester mesh were the probable causes. The second generation Dardik Biograft aimed at reducing these formations. The success of this new processing remains to be evaluated.
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