Arteriovenous graft life in chronic hemodialysis. A need for prolongation

D. D. Bell and J. J. Rosental
Long Beach Surgical Group, CA.

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.