Primary Vascular Access for Chronic Hemodialysis: A Comparison of Arteriovenous Fistulae with PTFE Grafts

Abstract

The purpose of this study was to compare patency rates of arteriovenous fistula (AVF) and polytetrafluoroethylene grafts (PTFE) for hemodialysis and the complications associated with each. All new permanent vascular access procedures for hemodialysis performed at one institution between January 1989 and December 1993 were reviewed with follow-up to December 1995. Patient demographics, secondary operations, complications, and length of stay were compared between the two types of access strategies. Seventy-seven PTFE and 89 AVF were performed in 166 patients. Age, sex, and frequency of diabetes were similar between the two groups. Primary patency rate at 36 months for AVF was 53%, compared with 16% for PTFE (p<0.01). Secondary patency rate at 36 months was 70% for AVF and 50% for PTFE (p<0.02). PTFE was associated with more hospital days per patient per year (26 vs 6.9), more infections (12 vs one during secondary patency interval), and a higher initial failure rate (19 vs eight) as compared with AVE. Patient survival rate at 4 years was higher for those with AVF (65% vs 52%). We conclude that an AVF as the primary access procedure for new renal dialysis patients is preferable to PTFE whenever possible.