Polyurethane Grafts: A Viable Alternative for Dialysis Arteriovenous Access?

Abstract

Polyurethane grafts, promoted for their self-sealing properties and low complication rates, were recently introduced for hemodialysis access. We review our experience with this graft material to determine its complication and patency rates. Between January 1995 and December 1999, 118 patients, 75 female and 43 male, with a mean age of 51 years, had a total of 163 polyurethane arteriovenous grafts inserted. The grafts were mostly 6 mm in diameter (69.3%), placed in a loop configuration (91.4%) in the forearm (49.7%). The median follow-up period was 12 months. The grafts were first cannulated for hemodialysis at a median time of 19 days after implantation, with 12% used within 3 days. Thrombosis and infection were the most common complications at rates of 32.7% and 30.0%, respectively. Infection was the most common cause of graft loss (61.5%). These complications were amenable to salvage intervention. The 1-year primary and secondary patency rates were 73% and 86%, respectively; the 3-year secondary patency rate, 72%. The 1-year serviceability rate was 64%. With satisfactory patency rates and the advantage of its self-sealing properties permitting early cannulation, polyurethane grafts provide a viable alternative for hemodialysis access. Early recognition and appropriate management of complications can prolong graft survival.

Patency rate and complications of polytetrafluoroethylene grafts compared with polyurethane grafts for hemodialysis access

“…Nowadays, polytetrafluoroethylene (PTFE) and polyurethane (PVAG) are among the most frequently used vascular grafts in the world (1,6,11). Several studies have reported different complications and patency rates for these artificial grafts.…”

“…The prolonged survival of this group of patients depends on the long-term functioning and patency of the vascular access for hemodialysis (1). Prosthetic vascular grafts are inevitably used for patients whose vessels are unsuitable for an autogenous arteriovenous (AV) fistula due to several reasons, especially diabetes mellitus-derived atherosclerosis (2).…”

Increased Risk of Infection Associated with Polyurethane Dialysis Grafts

“…Since enrollment in the randomized study was limited to patients receiving an upper extremity graft (1), it is not clear whether its conclusions can be generalized to polyurethane grafts placed in the thigh. Other published series of polyurethane grafts have reported an infection rate of 3–30% (3–7). These studies varied in the proportion of patients receiving thigh grafts and in the time to first graft cannulation, and lacked appropriate control patients with PTFE grafts.…”

Innovationen von Dialyseshuntprothesen

“…Es ist das am meisten genutzte synthetische Material in der Dialyseshuntchirurgie. Daneben findet seit mehreren Jahren auch Polyurethan Verwendung [15,23].…”