Ambulatory surgery for PTFE grafts for dialysis

Abstract

All prosthetic vascular accesses for hemodialysis performed in an ambulatory surgical setting between January 1992 and December 1996 were reviewed retrospectively. During this period, 400 out of the 450 vascular accesses with PTFE grafts (88.9%) were performed as outpatient cases. All operations were under local aesthesia without premedication. There were no postoperative deaths. Early complications were as follows: mild postoperative bleeding (readily controlled by local pressure): three (0.75%); surgical site infection: three (0.75%); early thrombosis (successfully treated with rescue surgery within the first 48 h, also in an ambulatory setting): four (1%). Four patients needed hospital admission (1%), one due to threatening arrhythmia, another because of anaphylactic reaction to cephazoline and two because of severe metabolic disorders. There was no increase in morbidity when the patients travelled long distances from the hospital to their homes immediately after the operation. These results show that prosthetic vascular accesses can be constructed and repaired in patients under local aesthesia and in an ambulatory surgical setting without an increase in morbidity. Delays due to waiting lists can be avoided, less resources are required, and complications associated with the prolonged use of central vein catheters for temporary hemodialysis can be reduced.