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Arteriovenous Graft Life in Chronic Hemodialysis: A Need for Prolongation

Arteriovenous Graft Life in Chronic Hemodialysis: A Need for Prolongation Abstract • As long-term hemodialysis has become well accepted over the last 25 years, so has the need for more exacting and updated techniques for arteriovenous graft construction. The death rate for patients with chronic renal failure undergoing biweekly or triweekly hemodialysis was once generally 10% per year. This pertained to a small, highly selected group of good-risk younger patients. Advancement in dialysis technology and experience has failed to reduce this rate. Essentially, all patients (including ill, elderly, and high-risk patients) are now candidates for long-term hemodialysis. In many cases, prolonged patient survival has added new importance to the extension of arteriovenous graft life. Over the last five years, approximately 1300 arteriovenous graft salvage procedures and new constructions have been performed. Of these, 70% were thrombectomies and revisions for graft salvage. Simple thrombectomy and removal of accumulated neointimal hyperplastic material along the course of the PTFE graft, and especially at the graft-venous anastomotic junction, can often extend graft life another six months to one year or more and permit immediate usage postoperatively. Graft life is even more prolonged with patch angioplasty at venous outflow stenoses or by adding a new segment of PTFE to bypass areas of venous stenosis. Conservation of unused extremities for future arteriovenous graft construction is our goal. (Arch Surg 1988;123:1169-1172) References 1. Pendras JP, Pollard TL: Eight years' experience with a community dialysis center: The Seattle artificial kidney center . Trans Am Soc Artif Int Organs 1970;16:77. 2. Tenckhoff A, Curtis FK: Experience with maintenance peritoneal dialysis in the home . Trans Am Soc Artif Int Organs 1970;16:90. 3. End-Stage Renal Disease (ESRD) Program of Medicare, Network Coorindating Council No. 4. 1986 Annual Report . Baltimore, Dept of Health and Human Services, Health Care Financing Administration, Office of Special Programs, 1987. 4. Palder SB, Kirkman RL, Whitemore AD, et al: Vascular access for hemodialysis . Ann Surg 1985;202:235-239.Crossref 5. Rosental JJ, Bell DD, Gaspar MR, et al: Prevention of high flow problems of arteriovenous grafts . Am J Surg 1980;140:231-233.Crossref 6. Glanz S, Gordon DH, Butt KM, et al: The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas . Ann Surg 1987;206:77-81.Crossref 7. Raju S: PTFE grafts for hemodialysis access . Ann Surg 1987;206:5.Crossref 8. Bhat DJ, Tellis VA, Kohlberg WL, et al: Management of sepsis involving expanded PTFE grafts for hemodialysis access . Surgery 1980;17:4. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Arteriovenous Graft Life in Chronic Hemodialysis: A Need for Prolongation

Archives of Surgery , Volume 123 (9) – Sep 1, 1988

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400330149023
Publisher site
See Article on Publisher Site

Abstract

Abstract • As long-term hemodialysis has become well accepted over the last 25 years, so has the need for more exacting and updated techniques for arteriovenous graft construction. The death rate for patients with chronic renal failure undergoing biweekly or triweekly hemodialysis was once generally 10% per year. This pertained to a small, highly selected group of good-risk younger patients. Advancement in dialysis technology and experience has failed to reduce this rate. Essentially, all patients (including ill, elderly, and high-risk patients) are now candidates for long-term hemodialysis. In many cases, prolonged patient survival has added new importance to the extension of arteriovenous graft life. Over the last five years, approximately 1300 arteriovenous graft salvage procedures and new constructions have been performed. Of these, 70% were thrombectomies and revisions for graft salvage. Simple thrombectomy and removal of accumulated neointimal hyperplastic material along the course of the PTFE graft, and especially at the graft-venous anastomotic junction, can often extend graft life another six months to one year or more and permit immediate usage postoperatively. Graft life is even more prolonged with patch angioplasty at venous outflow stenoses or by adding a new segment of PTFE to bypass areas of venous stenosis. Conservation of unused extremities for future arteriovenous graft construction is our goal. (Arch Surg 1988;123:1169-1172) References 1. Pendras JP, Pollard TL: Eight years' experience with a community dialysis center: The Seattle artificial kidney center . Trans Am Soc Artif Int Organs 1970;16:77. 2. Tenckhoff A, Curtis FK: Experience with maintenance peritoneal dialysis in the home . Trans Am Soc Artif Int Organs 1970;16:90. 3. End-Stage Renal Disease (ESRD) Program of Medicare, Network Coorindating Council No. 4. 1986 Annual Report . Baltimore, Dept of Health and Human Services, Health Care Financing Administration, Office of Special Programs, 1987. 4. Palder SB, Kirkman RL, Whitemore AD, et al: Vascular access for hemodialysis . Ann Surg 1985;202:235-239.Crossref 5. Rosental JJ, Bell DD, Gaspar MR, et al: Prevention of high flow problems of arteriovenous grafts . Am J Surg 1980;140:231-233.Crossref 6. Glanz S, Gordon DH, Butt KM, et al: The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas . Ann Surg 1987;206:77-81.Crossref 7. Raju S: PTFE grafts for hemodialysis access . Ann Surg 1987;206:5.Crossref 8. Bhat DJ, Tellis VA, Kohlberg WL, et al: Management of sepsis involving expanded PTFE grafts for hemodialysis access . Surgery 1980;17:4.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1988

References