Polytetrafluoroethylene graft survival in hemodialysis

Expanded polytetrafluoroethylene (PTFE) graft fistulas are widely used as secondary vascular access for patients receiving long-term hemodialysis treatment. Sixty-seven grafts were implanted in 48 patients and followed for 12 to 51 months. Cumulative patency for all grafts at 12 months was 67% ±6%, at 24 months 50%±7%, and at 48 months 43%±9%. Graft survival rates were different when considering graft configuration and location. Forearm straight graft survival at 12 months was 35%± 13%, upper arm curved grafts 60%±19%, and forearm looped grafts 78%±7%. Complications that decreased graft survival were related to thrombosis (21%), infection (25%), and intimal hyperplasia at the venous anastomosis (34%). After reviewing our experience, we believe that the challenge of secondary vascular access has not been solved by PTFE grafts. This should stimulate the search for better grafts and techniques. (JAMA1983;249:219-222)