| Theme | Current Topics in Hemodialysis Vascular Access | |
|---|---|---|
| Title | Patency of expanded polytetrafluoroethylene arteriovenous vascular access grafts (AVGs) -- Collaboration of interventional therapy | |
| Publish Date | 2005/11 | |
| Author | Toyomu Ugawa | Division of Vascular Access Surgery, Second Department of Internal Medicine, Faculty of Medicine, Kagawa University |
| [ Summary ] | To assess whether an interventional therapy protocol that includes preimplantation identification of inflow and outflow vessels with the use of digital subtraction angiography (DSA) and early postoperative percutaneous transluminal angioplasty (PTA) and if treatment would improve secondary patency rates for expanded polytetrafluoroethylene (ePTFE) vascular access grafts in patients undergoing long-term hemodialysis. Patency data were obtained from the records of 106 patients who underwent synthetic bridge graft implantation and PTA, according to the protocol, over the past 4.5 years. Data were analyzed by using the Kaplan-Meier life-table method, as well as other assessments. In 89 of 106 patients, the patency of stenosed access grafts was restored by using PTA. 102 patients achieved secondary graft patency. In the other 4 patients, restoration of patency was not possible because of heparin-induced thrombosis, infection, or steal syndrome. Using the Kaplan-Meier analysis, the 3-year cumulative patency rate in the series was 95.9 %. Patients who underwent graft implantation or endografting in the same arm as the faild access generally had less need for PTA over time. Interventional therapy to treat stenoses effectively maintains the secondary patency of ePTFE vascular access grafts. DSA is useful for preoperative identification of the inflow artery and the outflow vein that will allow optimal PTA. Use of the basilic vein in the upper arm for the outflow vessel facilitates postoperative management of vascular access. |
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