Outcomes With Heparin-Bonded Expanded Polytetrafluoroethylene Grafts Used as a Conduit for Hemodialysis

Background: Obtaining and maintaining dialysis access after failure of autologous access sites remains a concern for access surgeons. PTFE is the most common conduit used. Heparin-bonded expanded PTFE graft (Gore PropatenVascular Graft) may offer benefits because it is designed to provide resistance to thrombosis and decrease the development of intimal hyperplasia.
Purpose: This retrospective study reviews clinical outcomes using this graft as a hemodialyisis access conduit since its introduction in 2006.
Method: From March 2007 to March 2008, 50 patients (23 males (46%) mean age of 58.7 yo) all adults with ESRD, underwent placement of arteriovenous Heparin-bonded ePTFE graft. Patency, re-intervention, infection and access function rates were examined, and factors influencing their outcomes determined.
Results: All grafts were patent immediately after implantation. During a mean follow-up time of 24 months, only 14 (28%) patients are still successfully using the graft for hemodialysis. A total of 24 (48%) patients died of non-graft related causes during the follow up period. 19 cases of thrombosis occurred, 7 resolved after secondary intervention. Wound infection occurred in 7 (14%) patients and 1 patient required graft removal. 6 (12%) cases of pseudoaneurysm occurred and 8 (16%) of steal syndrome were reported. Primary patency rate (PPR), Assisted primary patency rate (APPR) and Secondary patency rate (SPR) of the graft are summarize in table I.
Conclusion: Heparin-bonded ePTFE graft is a viable alternative for hemodialyisis access. In this retrospective study this graft demonstrated encouraging results superior to the current literature controls. However, long-term prospective and randomized studies are necessary to determine whether this graft provides results superior to those achieved with other prostheses.