Document Detail

Effects of a venous cuff at the venous anastomosis of polytetrafluoroethylene grafts for hemodialysis vascular access.
MedLine Citation:
PMID:  11107088     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION AND METHODS: The most frequent complication of polytetrafluoroethylene (PTFE) arteriovenous grafts for hemodialysis is thrombotic occlusion due to stenosis caused by intimal hyperplasia. This complication is also known for peripheral bypass grafts. Because the use of a venous cuff at the distal anastomosis improves the patency of peripheral bypass grafts, we considered that it might also improve the patency of PTFE arteriovenous grafts. Therefore, a randomized multicenter trial was carried out to study the effect of a venous cuff at the venous anastomosis of PTFE arteriovenous grafts on the development of stenoses and the patency rates.
RESULTS: Of the 120 included patients, 59 were randomized for a venous cuff. The incidence of thrombotic occlusion was lower in the cuff group (0.68 per patient-year) than in the no-cuff group (0. 88 per patient-year; P =.0007). However, the primary and secondary patency rates were comparable. The cuff group tended to have fewer stenoses at the venous and arterial anastomoses when examined with duplex scan. Graft failure was higher in patients with an initial anastomosing vein diameter smaller than 4 mm (7 of 18 [39%]) than in those with a vein diameter of 4 mm or larger (16 of 88 [18%]; P =. 052). Local edema, skin atrophy, and obesity yielded a higher risk on graft failure (23% vs 11%).
CONCLUSION: A venous cuff at the venous anastomosis of PTFE arteriovenous grafts for hemodialysis reduced the incidence of thrombotic occlusions; stenosis at the venous anastomosis was reduced. However, this did not result in a better patency rate. Therefore, the venous cuff should not be used routinely. Initial vein diameter and local problems (edema, obesity, or skin atrophy) appear to be the most important risk factors for graft failure.
M S Lemson; J H Tordoir; R J van Det; R J Welten; H Burger; R J Estourgie; H J Stroecken; K M Leunissen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  32     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2001-01-08     Completed Date:  2001-01-08     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1155-63     Citation Subset:  IM    
Department of Surgery at the University Hospital, Maastricht, The Netherlands.
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MeSH Terms
Arteriovenous Shunt, Surgical / adverse effects,  methods*
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Data Interpretation, Statistical
Follow-Up Studies
Graft Occlusion, Vascular / etiology,  prevention & control
Middle Aged
Prospective Studies
Renal Dialysis*
Risk Factors
Time Factors
Ultrasonography, Doppler, Duplex
Vascular Patency
Veins / transplantation*
Reg. No./Substance:
Comment In:
J Vasc Surg. 2000 Dec;32(6):1235-6   [PMID:  11107101 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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