Medium-term follow-up of forty autogenous vein and forty polytetrafluoroethylene (Gore-Tex) grafts for vascular access.

Patency of 40 polytetrafluoroethylene (PTFE) and 40 autogenous vein arteriovenous grafts for vascular access among 56 patients is compared. Most patients required access for hemodialysis, but six grafts were for other reasons including hyperalimentation and drug administration. Cumulative patency at 3 years for both PTFE grafts and vein grafts was 64%. The complication rate necessitating secondary operation was more than three times greater in the PTFE group in which 35 secondary procedures were needed. No grafts became infected as a result of the initial operation, but eight serious complications were associated with subsequent infection of PTFE grafts and three with vein grafts, including postcannulation bleeding, abscess, and aneurysm. Twenty-six PTFE grafts developed associated stenosis in the runoff vein. This was demonstrated with angiography in 10 and the stenoses were excised and grafted, one being dilated by intravascular balloon. In 16 thrombosis was the first indication of stenosis. Histologically narrowed runoff veins showed intimal hyperplasia. Runoff stenosis did not occur among vein grafts, but in eight vein grafts themselves became stenotic. These results indicate that owing to a higher complication rate with PTFE grafts, vein grafts should be used when possible.