Long-term outcome of a cuffed expanded PTFE graft for hemodialysis vascular access.

Abstract

Development of venous outflow stenosis has been a major obstacle in maintaining the patency of dialysis vascular grafts. In the present study, we retrospectively analyzed the long-term results of cuffed expanded polytetrafluoroethylene (ePTFE) and non-cuffed (standard) ePTFE grafts placed for hemodialysis access. A total of 67 patients who underwent placement of either cuffed (n = 41) or standard (n = 26) ePTFE grafts were retrospectively analyzed. There were no significant differences between the two groups with regard to age, gender, cause of end-stage renal disease, and anatomic placement of the graft. Endpoints consisted of primary (without any intervention) and secondary (with radiological or surgical intervention) graft patency rates at 1-3 years. There was a trend toward better primary graft patency rates in the cuffed versus the standard ePTFE: 37.7% vs. 25.7% at 1 year, 35% vs. 10.3% at 2 years, 28% vs. 5.1% at 3 years, respectively (p = 0.086, Kaplan-Meier). Secondary patency rates in the cuffed group were significantly superior (p = 0.047) to those in the standard group (81.8% vs. 56.1% at 1 year, 61.8% vs. 46.3% at 2 years, 51.5% vs. 33.1% at 3 years, respectively). Thrombosis as a cause of complete graft failure was significantly higher (34%) in the standard group than in the cuffed group (9%) (p = 0.0125). Compared to the standard ePTFE, the cuffed ePTFE graft provided better long-term outcome, especially in terms of secondary patency rates after radiological intervention.