Prosthetic Graft Fistulas: The expanded PTFE Graft

Abstract

Multiple technological and procedural advances in the technique for hemodialysis have evolved since Kolff in 1944 described his original “dialyzer” [1]. This expansion in methods of angioaccess has an implicit bearing on the proliferation of hemodialysis, so that today virtually no patient in renal failure is denied such therapy. An estimated 70,000 patients in the United States alone are currently enrolled in a hemodialysis program. Progressive knowledge of the management of renal failure and its complications has placed demands on vascular surgeons to create and maintain access to the arteries and veins for the purpose of achieving successful hemodialysis. External shunts, internal shunts, percutaneous venous catheters, primary arteriovenous (AV) fistulas, autogenous bridge fistulas, and prosthetic fistulas have all been used for hemo-access with variable success. The gold standard for hemoaccess remains the primary AV fistula as described by Brescia and Cimino in 1966 [2]. However, conditions for creation of this classic fistula are not always present and some alternative form of hemoaccess is indicated. Expanded polytetraftuoroethylene (c-PTFE) has evolved as a highly successful prosthetic material for use in the creation of secondary forms of hemoaccess.