Abstract
Establishment of blood access for maintenance hemodialysis patients with unsuitable superficial vein is a continuing challenge. In that circumstances, saphenous autovein and various synthetic materials including dacron, bovine arterial graft and swine arterial graft have been used for the A-V fistula. Recently the use of expanded microporous polytetrafluoroethylene grafts have demonstrated successful replacement of small artery and portal vein. In our hospital, A-V fisturae were established in 15 patients using E-PTFE grafts (IMPRA) between September 1976, and March 1977. The grafts using, less than 0.5mm in wall thickness, 20-30μm in internodal space, 0.30mg/ml in density and 20-30cm in length. In 5 cases, thrombosis (2 cases), stenosis of the run off vein (2 cases) and pseudoaneurysma (1 case) were encountered and 4 were salvaged by successful revision, but one was failed. The patency rate of E-PTFE grafts is 93.7% during our observation period, from 2 to 9 months following opration. In grafts, the PTFE lattice demonstrated complete cellular incorporation by the fibrous tissue and the new capillary ingrowth. In addition, there is a smooth and thin neointima in the inner surface of the graft and the firm collagenous penprosthetic “adventitial” attachment.
