ABSTRACT
Between 1970 and 1991, we placed 1,090 grafts (bovine and polytetrafluoroethylene) in 1,041 patients and created 1,034 autogenous fistulas in 856 patients for hemodialysis. Subsequent revisions for complications resulted in a total of 3,944 operations performed in patients with grafts and 1,633 operations in patients with autogenous fistulas. A total of 255 infections developed in 158 of the patients with grafts, whereas 8 infections developed in 7 patients with autogenous fistulas. The puncture infection rate was 5%/yr (12%/yr for a second puncture infection). The clean wound infection rate was 3% for grafts and 0.4% for autogenous fistulas. We made an attempt to salvage the graft, usually with a segmental bypass, in 75% of patients with a graft infection. Grafts were salvaged in 80% of patients in whom salvage was attempted (60% of all patients with an infection). The results in the few patients with infected autogenous fistulas were relatively poor.
Subject(s)
Catheters, Indwelling/adverse effects , Renal Dialysis/adverse effects , Staphylococcal Infections/surgery , Surgical Wound Infection/surgery , Vascular Surgical Procedures , Adult , Arteriovenous Shunt, Surgical/adverse effects , Blood Vessel Prosthesis/adverse effects , Female , Follow-Up Studies , Humans , Male , Reoperation , Staphylococcal Infections/etiology , Surgical Wound Infection/etiologyABSTRACT
A randomized study of transluminal angioplasty versus surgical revision for stenosis at the venous end of hemodialysis grafts was carried out. Median patency for the surgical group was 12 months versus only 4 months for the transluminal angioplasty group. This difference was statistically significant (p less than 0.01). In addition, the average cost for surgical revision was slightly less than that for transluminal angioplasty. Therefore, for long-term patency, surgical treatment is the method of choice, although under special circumstances there may still be a role for transluminal angioplasty.
Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical , Graft Occlusion, Vascular/therapy , Renal Dialysis , Angioplasty, Balloon/economics , Arteriovenous Shunt, Surgical/economics , Blood Vessel Prosthesis , Evaluation Studies as Topic , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/economics , Humans , Prosthesis Failure , Radiography , Random AllocationABSTRACT
Scribner shunts were converted to arteriovenous fistulas in twenty-six patients, with long-term success in twenty patients. Infection with loss of the fistula was a problem in two patients. The fistulas were used for home as well as center dialysis and as a primary blood access site as well as a backup site.
