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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Gyedu A., Koksoy C., Hazinedaroglu S.M., Tulga Ulus A., Yerdel M.A.
1 Ankara University Medical School, Department of Surgery, Ankara, Turkey
2 Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
Aim. The number of patients requiring hemodialysis is increasing by the year, with a large number of patients still requiring prosthetic grafts for hemodialysis. The aim of this study was to assess the clinical performance status of a heparin bonded, polycarbonate/urethane graft (PUG) for hemodialysis access.
Methods. Between May 1999 and December 2002, 52 heparin bonded, PUG’s were implanted in 49 patients who had prior had at least one failed arteriovenous (AV) access. Twenty grafts were placed in the upper arm, 16 in the thigh, 15 on the anterior chest wall, and 1 in the forearm. Patency was determined by Kaplan-Meier analysis, and the Cox proportional hazards model was used for multivariate analysis of factors predictive of effect.
Results. The mean follow-up period was 1295 days. One-year primary and secondary patency rates were 45% and 73% respectively. Twenty five successful thrombectomies in 17 patients and one successful fibrinolytic therapy was performed to salvage occluded grafts. During thrombectomy, venous anastomoses were revised (n=7) in 6 patients. Graft infection developed in 10 patients (19%) and infected grafts were removed in nine (17%) patients. Grafts were punctured within first 24 hours after the implantation in three patients without any complications.
Conclusion. Our experience indicates that the heparin bonded, PUG seems to be a safe and effective choice for vascular access with acceptable patency and infection rates and it will be especially suitable for patients who require early access.