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. 1992 Nov;216(5):596–599. doi: 10.1097/00000658-199211000-00012

A prospective evaluation of plasma-TFE and expanded PTFE grafts for routine and early use as vascular access during hemodialysis.

T S Helling 1, P W Nelson 1, L Shelton 1
PMCID: PMC1242679  PMID: 1444652

Abstract

The use of prosthetic grafts as vascular access for chronic hemodialysis is frequently necessary in patients with end-stage renal disease. Most commonly, expanded polytetrafluoroethylene (e-PTFE) has been employed because of ease of handling, tissue inertness, and acceptable long-term patency. Delay in use to allow for tissue ingrowth, however, has often required placement of temporary access devices. The authors have undertaken evaluation of a new material, plasma polymerized woven dacron Plasma-TFE, in a prospective randomized trial (Plasma-TFE VA) to compare clinical behavior against e-PTFE grafts, and we have used the Plasma-TFE grafts in an additional group of patients (Plasma-TFE AVA) as early access (within 1 week of implantation). Twenty-one Plasma-TFE grafts were implanted in 19 patients and 19 e-PTFE grafts were implanted in 17 patients in a prospective randomized fashion. Additionally, 31 Plasma-TFE grafts were implanted in 31 nonrandomized patients for early access. Primary patency rates in Plasma-TFE VA and e-PTFE grafts were equivalent at 12 months (0.471 and 0.556). When Plasma-TFE AVA primary patency was included (0.621), comparisons were not statistically significant (p = 0.50). Similarly, secondary patency rates among the three groups did not differ (cumulative proportion patent at 12 months: Plasma-TFE VA 0.403, e-PTFE 0.658, Plasma-TFE AVA 0.510). In considering after-revision patency after graft thrombosis, however, the Plasma-TFE grafts (both VA and AVA) performed significantly more poorly (p = 0.027) than e-PTFE grafts. Incidence of graft infection, wound infection, arm edema, hematoma from use, and occurrence of distal limb ischemia between Plasma-TFE (VA and AVA) and e-PTFE did not differ statistically. The authors conclude that Plasma-TFE compares favorably to e-PTFE with respect to primary and secondary patency and nonthrombotic complications, even with early use. Plasma-TFE does not perform as well as e-PTFE, however, after graft thrombosis.

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Selected References

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  1. Barrett N., Spencer S., McIvor J., Brown E. A. Subclavian stenosis: a major complication of subclavian dialysis catheters. Nephrol Dial Transplant. 1988;3(4):423–425. doi: 10.1093/oxfordjournals.ndt.a091691. [DOI] [PubMed] [Google Scholar]
  2. Brescia M. J., Cimino J. E., Appel K., Hurwich B. J. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966 Nov 17;275(20):1089–1092. doi: 10.1056/NEJM196611172752002. [DOI] [PubMed] [Google Scholar]
  3. Canizales S., Charara J., Gill F., Guidoin R., Roy P. E., Bonnaud P., Laroche G., Batt M., Roy P., Marois M. Expanded polytetrafluoroethylene prostheses as secondary blood access sites for hemodialysis: pathological findings in 29 excised grafts. Can J Surg. 1989 Nov;32(6):433–439. [PubMed] [Google Scholar]
  4. Dorner D. B., Stubbs D. H., Shadur C. A., Flynn C. T. Percutaneous subclavian vein catheter hemodialysis--impact on vascular access surgery. Surgery. 1982 Jun;91(6):712–715. [PubMed] [Google Scholar]
  5. Dunn J., Nylander W., Richie R. Central venous dialysis access: experience with a dual-lumen, silicone rubber catheter. Surgery. 1987 Nov;102(5):784–789. [PubMed] [Google Scholar]
  6. Etheredge E. E., Haid S. D., Maeser M. N., Sicard G. A., Anderson C. B. Salvage operations for malfunctioning polytetrafluoroethylene hemodialysis access grafts. Surgery. 1983 Sep;94(3):464–470. [PubMed] [Google Scholar]
  7. Fant G. F., Dennis V. W., Quarles L. D. Late vascular complications of the subclavian dialysis catheter. Am J Kidney Dis. 1986 Mar;7(3):225–228. doi: 10.1016/s0272-6386(86)80008-7. [DOI] [PubMed] [Google Scholar]
  8. Fillinger M. F., Reinitz E. R., Schwartz R. A., Resetarits D. E., Paskanik A. M., Bruch D., Bredenberg C. E. Graft geometry and venous intimal-medial hyperplasia in arteriovenous loop grafts. J Vasc Surg. 1990 Apr;11(4):556–566. [PubMed] [Google Scholar]
  9. Kherlakian G. M., Roedersheimer L. R., Arbaugh J. J., Newmark K. J., King L. R. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg. 1986 Aug;152(2):238–243. doi: 10.1016/0002-9610(86)90249-7. [DOI] [PubMed] [Google Scholar]
  10. Parker N. R., Caywood D. D., Shankerelli K., Hall A., 3rd A study to compare the healing of a Plasma-TFE synthetic artery in the dog. J Invest Surg. 1989;2(4):457–470. doi: 10.3109/08941938909018271. [DOI] [PubMed] [Google Scholar]
  11. Pourchez T., Morinière P., Fournier A., Pietri J. Use of Permcath (Quinton) catheter in uraemic patients in whom the creation of conventional vascular access for haemodialysis is difficult. Nephron. 1989;53(4):297–302. doi: 10.1159/000185771. [DOI] [PubMed] [Google Scholar]
  12. Raju S. PTFE grafts for hemodialysis access. Techniques for insertion and management of complications. Ann Surg. 1987 Nov;206(5):666–673. doi: 10.1097/00000658-198711000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Spinowitz B. S., Galler M., Golden R. A., Rascoff J. H., Schechter L., Held B., Charytan C. Subclavian vein stenosis as a complication of subclavian catheterization for hemodialysis. Arch Intern Med. 1987 Feb;147(2):305–307. [PubMed] [Google Scholar]
  14. Steed D. L., McAuley C. E., Rault R., Webster M. W. Upper arm graft fistula for hemodialysis. J Vasc Surg. 1984 Sep;1(5):660–663. doi: 10.1067/mva.1984.avs0010660. [DOI] [PubMed] [Google Scholar]
  15. Swedberg S. H., Brown B. G., Sigley R., Wight T. N., Gordon D., Nicholls S. C. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment. Circulation. 1989 Dec;80(6):1726–1736. doi: 10.1161/01.cir.80.6.1726. [DOI] [PubMed] [Google Scholar]
  16. Taucher L. A. Immediate, safe hemodialysis into arteriovenous fistulas created with a new tunneler. An 11 year experience. Am J Surg. 1985 Aug;150(2):212–215. doi: 10.1016/0002-9610(85)90122-9. [DOI] [PubMed] [Google Scholar]
  17. Yeh Y. S., Iriyama Y., Matsuzawa Y., Hanson S. R., Yasuda H. Blood compatibility of surfaces modified by plasma polymerization. J Biomed Mater Res. 1988 Sep;22(9):795–818. doi: 10.1002/jbm.820220904. [DOI] [PubMed] [Google Scholar]

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