Prosthetic arteriovenous grafts for hemodialysis

[okarol]

J Vasc Access 2009; 10: 137 - 147
Prosthetic arteriovenous grafts for hemodialysis

published online: 05/05/2009

Jacob A. Akoh
Abstract

Introduction: Prosthetic arteriovenous (AV) grafts are indicated in patients with failed AV fistula (AVF), exhausted
superficial veins or unsuitable vessels. Increasing the proportion of prevalent hemodialysis (HD) patients using autogenous AVF should reduce the need for AV grafts and associated morbidity. This paper reviews the current role of prosthetic AV grafts in vascular access for HD.
Technical considerations: Prior to the insertion of a prosthetic AV graft, a comprehensive review of previous access procedures and full physical examination in addition to vessel mapping is required. Anastomotic technique should take into account the flow diffuser concept, graft geometry and an anastomotic angle of 15° in order to reduce the incidence of intimal hyperplasia.
Results: Many authors report 1 and 2-yr cumulative graft patency rates of 59-90% and 50-82%, respectively. The major drawbacks with synthetic grafts include: thrombosis, a five-fold increase in infection risk and steal syndrome. The choice between surgical and percutaneous methods of dealing with blocked AV grafts remains controversial, though percutaneous techniques are assuming an increasingly important role. Percutaneous strategies are successful in declotting access in 67-95% of cases. Stenting of stenotic lesions following thrombectomy improves secondary patency rates. Strategies for dealing with AV graft infection include antibiotic prophylaxis, partial, subtotal or total graft excision and the use of biological prosthesis.
Conclusions: Though more prone to complications than autogenous AVFs, AV grafts offer a short maturation period and are more amenable to thrombectomy by radiological or surgical means. Complex AV grafts may be appropriate in patients with exhausted access sites.

full article in PDF: http://www.vascular-access.info/public/JVA/Article/Articleabstract.aspx?UidArticle=4D7ACE81-D470-4789-9F85-A8360254AF3B&t=JVA

[Chris]

First time I have seen that my graft is considered a prothetic device. However I had no maping done, nor was aware if it was available back in 1999. Fistula failed and surgeon used a graft instead of trying another graft. Only problem I have had with it is that it is itchy and can easily draw blood from scatching due to the graft poking up. Other than that, it is unsightly 

[Hanify]

First time I have seen that my graft is considered a prothetic device. However I had no maping done, nor was aware if it was available back in 1999. Fistula failed and surgeon used a graft instead of trying another graft. Only problem I have had with it is that it is itchy and can easily draw blood from scatching due to the graft poking up. Other than that, it is unsightly 

I'm sure on you it looks sexy Chris.

[Chris]

  Hanify, Yeah Right!

I do have a bridge to sell