Graft rescue for haemodialysis arterio-venous grafts: is it worth doing and which factors predict a good outcome?

Abstract

Arterio-venous grafts in patients with end-stage renal failure are used when the patients have inadequate native veins or where there is an urgent need for permanent vascular access. Complications include thrombosis, bleeding, infection and pseudoaneurysm formation. The factors causing thrombosis can be divided into patient-related and graft-related factors. In this study 47 graft rescues in 24 patients were analysed. Polytetrafluoroethylene (PTFE) and polyurethane grafts were used. A successful graft rescue was defined as one in which a thrill was felt after surgical thrombectomy and the graft was subsequently used for haemodialysis. Eighteen grafts were PTFE and 10 were polyurethane; there were 15 women and nine men. There were 20 successful and 27 unsuccessful rescues, the overall success rate being 42.6% (20/47 rescues). Evidence of underlying stenoses was found in 14 graft rescues: 11 were at the venous end, two at the arterial end and one at the apex. A vein patch was used in these patients. In successful graft rescues an identifiable structural cause was found in only seven (25.9%) of the failed graft rescues. In spite of the common belief that graft rescue is unproductive, this study has shown that graft rescue was successful in 42.6% of cases. This was especially so when there was a surgically correctable underlying graft stenosis.