AVF Creation Using Synthetic Graft

Oh, Ki Bong; Kwon, Tae Won; Cho, Yong Pil; Kim, Do Kyun; Kim, Geun Eun

Abstract

PURPOSE: Graft interposition arteriovenous fistula (GAVF) graft has been used for the chronic renal failure patients when autogenous arteriovenous fistular procedure is not feasible. Reported, mean first year primary patency rate of GAVF was 40~60%, and the secondary patency being 50~70%. The purpose of this study is to evaluate the patency rate of our AVF using synthetic graft, and factors influencing on the patency rate. METHOD: To evaluate the patency rate of GAVF and the causes of GAVF occlusion, we analyzed 430 cases of GAVF from January 1998 to December 2000. 430 graft interposition was performed on 357 patients, accounting 36.9% of the total 1163 AVF procedure. RESULT: The primary patency rate were 69.8% at the first and 66.6% at the second year. The mean occlusion free interval was 15.8 months. The secondary patency rate was 82.0% at the first year, and 71.2% at the second year. The mean secondary patency interval was 18.5 months. Early occlusion within 1month of surgery has been due to a misjudgement in evaluation of adequate artery and vein (11/16, 68.8%). Majority of the occlusion occurred after 5 months of surgery (37.8%). In late occlusion cases, the common causes were somewhat different. They were intimal hyperplasia at venous anastomosis site and improper hemostasis or sudden changes of hemodynamics during dialysis.
CONCLUSION
These data lead us to conclude that a skilled judgement of a surgeon is still the most important factor for successful AVF graft surgery in early outcome. Intimal hyperplasia at venous anastomosis site remains to be the main cause of long term failure.