Jenkins A M, Buist T A, Glover S D
Surgery. 1980 Nov;88(5):667-72.
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.
比较了56例患者中40例聚四氟乙烯（PTFE）动静脉移植物和40例自体静脉动静脉移植物用于血管通路的通畅情况。大多数患者需要进行血液透析通路，但有6例移植物用于其他原因，包括胃肠外营养和药物输注。PTFE移植物和静脉移植物3年时的累积通畅率均为64%。需要二次手术的并发症发生率在PTFE组中高出三倍多，该组需要35次二次手术。没有移植物因初次手术而感染，但有8例严重并发症与PTFE移植物随后的感染相关，3例与静脉移植物相关，包括插管后出血、脓肿和动脉瘤。26例PTFE移植物在流出静脉出现相关狭窄。其中10例经血管造影证实，狭窄部位被切除并进行移植，1例通过血管内球囊扩张。16例中血栓形成是狭窄的首发表现。组织学上，狭窄的流出静脉显示内膜增生。静脉移植物中未出现流出道狭窄，但有8例静脉移植物自身出现狭窄。这些结果表明，由于PTFE移植物的并发症发生率较高，应尽可能使用静脉移植物。
