Long-term follow-up of the polytetrafluoroethylene (PTFE) prosthesis as an arteriovenous fistula for haemodialysis.

During a 10-year period vascular access in 86 patients receiving long-term haemodialysis was provided by the insertion of 100 polytetrafluoroethylene grafts. In 24 patients (28%) the PTFE prosthesis was used as a primary access operation; 62 patients (72%) had had previous access procedures. Early thrombosis and infection led to graft failure in eight patients. Late fistula occlusion developed in 67 instances in 39 fistulae. Thrombectomies were performed in 53 fistulae with good result in 46 (86.8%). Infection after puncture was seen in nine grafts and was treated by incision and drainage (33%) or graft removal (67%). False aneurysms developed in six patients; prolonged haemorrhage from the puncture site occurred in one patient and haemodynamic complications (ischaemic steal syndrome; venous hypertension) developed in four. The cumulative patency of PTFE AV fistulae was 74% after 1 year; 59% after 2 and 3 years and 47% after a follow-up of 5 years. Despite the high rate of complications the PTFE AV fistula has proved an acceptable technique in secondary access surgery for haemodialysis.