Polytetrafluoroethylene Patch Closure at Venous Anastomotic Site: A Novel Technique for Arteriovenous Graft Salvage

Abstract

Introduction: The use of prosthetic arterio-venous grafts (avgs) is necessary in patients where all autogenous vein options are exhausted. This study asseses the results of PTFE patch plasty at the venous end of the access anastomosis. Materials and Methods: This is a prospective observational single centre study in a tertiary care centre for all patients with prosthetic AV graft venous anastomotic site stenosis between 2012 and 2015. Results: There were 40 patients in the study period. Presenting symptoms were primarily inadequate dialysis from AV Graft due to thrombosed graft within 14 days duration. The average age was 58.2 years and 70% were male. They underwent thrombectomy and PTFE patch closure at the venous anastomotic site due to AV graft thrombosis in upper extremity. 38.4% patients had both hypertension, Type II DM while 38.4% patients suffered from triad of hypertension, Type II DM and Hyperlipidemia. Criteria of success was based on immediate post operative bruit and next day heparin free hemodialysis from AV Graft. 37 patients who underwent the procedure had primary patency rate of 91.89% at 3 months and 59.45% at 6 months. Mean follow-up time was 8 months with average hospital stay of 3 days without post-operative complications. Conclusion: Treatment of AVG thrombosis should be performed urgently. There is no standard approach for AV graft thrombosis and surgical management must be individualized for each case. As the commonest cause of graft occlusion is at the venous anastomotic site, hence AV graft thrombectomy with eptfe patch closure can achieve better result compared to thrombectomy with primary closure or stent placement.