A new vascular graft technique for hemodialysis: Composite graft using polyurethane and expanded-polytetrafluoroethylene.

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  • ポリウレタン製人工血管（ソラテック）を用いた内シャントにおける術式の工夫　　コンポジットグラフトの有用性
  • Composite graft using polyurethane and expanded-polytetrafluoroethylene
  • コンポジットグラフトの有用性

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Expanded polytetrafluoroethylene (E-PTFE) has acceptable long-term patency, good suturability, and good flexibility. However, there are several drawbacks in the use of this graft for hemodialysis. These drawbacks include the development of local edema, seroma, and poor closure of the puncture hole. To overcome these problems, a new polyurethane access graft has been developed. Unfortunately, polyurethane grafts also have disadvantages, such as problems with frequent kinking when implanted over elbow joints. To combine the immediate access advantages of polyurethane and the excellent flexibility of E-PTFE, a composite graft was therefore constructed. This composite graft consists of E-PTFE for several centimeters (3 to 11cm) near the venous anastomosis site and of polyurethane for the remainder of the graft.<br>Between June 1997 and December 1999, 31 vascular grafts over elbow joints including 11 composite loop grafts (Group C), 5 polyurethane (Thoratec®) loop grafts (Group T), and E-PTFE loop grafts were implanted in the forearm of 31 adult patients on maintenance hemodialysis in order to form arteriovenous fistulas. Three episodes of early thombosis resulting from kinking occurred in the forearm loop grafts of group T patients, while there were no episodes of thrombosis in group C or group P. There were no aneurysmal dilatations at the puncture site or seroma formations in any of the cases. Postoperative local edema did not develop in any patient in group C or group P. The overall cumulative patency in group C and group P were 83.3% and 90.9% after 1 year, whereas that in group T was significantly lower at 40.0%.<br>In conclusion, composite grafts for forearm loop grafts over the elbow joint are useful for avoiding problems associated with kinking. In cases of upper arm polyurethane grafts, loops constructed from the radial to the ulnar side are easier to perform.

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