Use of expanded polytetrafluoroethylene grafts for vascular access in hemodialysis: laboratory and clinical evaluation.

Vascular access for chronic hemodialysis has evolved considerably over the past 10 years with development of vascular substitutes. The bovine heterograft is the choice of most dialysis centers when a subcutaneous conduit is needed in lieu of an in situ arteriovenous fistula. Bovine grafts have solved some problems, but further improvement in blood access prostheses is needed. Polytetrafluoroethylene (PTFE) grafts were evaluated in a laboratory and clinical study. In animals, PTFE proved to be satisfactory for fistula construction based on patency, incorporation into tissue, and ease of puncture. Ten patients underwent 11 vascular access procedures using PTFE grafts as a conduit. There were no technical operative complications. One graft was occluded by extravasation during dialysis and flow could not be restored. Otherwise, all grafts are patent 9 to 18 months postoperatively. Grafts of 8.0 mm in diameter have not given desirable flow rates, whereas 6.0 mm grafts have. Prolonged bleeding from puncture has been a problem in some cases. Otherwise, PTFE appears to be a satisfactory conduit for hemodialysis vascular access.