Abstract
Recently, many problems related to access have arisen among long-term hemodialysis patients. Therefore, bovine or swine xenografts, synthetic grafts, saphenous vein autografts and Dardik Biografts are currently in use. Such grafts are used for internal access. But their maintenance is very difficult, because of infection, pseudoaneurythm, hematom, obstruction and many problems related to the puncture.
Therefore, we tried to change to the external access using E-PTFE grafts from the internal access, which in volved repeated re-operations. The change resulted in a significant decrease of complications.
Among 875 cases operated on during the last three years, 26 external accesses using E-PTFE grafts were constructed in 14 long-term hemodialysis patients. They compaised six males, and eight females whose mean of age was 48. The mean of the hemodialysis period was 7.4 years.
Thirteen patients are being maintained at present without complications. One case, however, required eight re-operations because of frequent obstruction and infection. Therefore, this patient was changed to the continuous ambulatory peritoneal dialysis (CAPD) method.
In spite of serious management for infection to maintain CAPD, the peritoneal tube was removed as a result of frequent peritonitis after several months. Thus, the external shunt constructed on the patient's femoral region is now maintained using a Gore Tex graft.
Internal access is ordinarily the first choice to maintain hemodialysis, but external access should be constructed in patients whose internal access using a synthetic graft results in many repeated complications. External access using a E-PTFE graft is well maintained even in complicated long-term hemodialysis patients.
