Surgery of Arteriovenous Interposition Grafts

Abstract

BACKGROUND: The history of vascular access surgery is marked by two milestones: firstly the invention of the subcutaneous arteriovenous fistula and secondly the introduction of an artificial interposition graft. The latter option has contributed to markedly increasing the number of patients on dialysis and also to extending their life expectancy, as the possibilities of creating a shunt with autologous tissue are exhausted early in many patients. Therefore the interposition graft has a high relative importance. An analysis of the actual options and limitations seems to be mandatory. Additionally is to be examined if and which improvements can be expected. METHODS: Indications, technical procedures, complications, different types of prostheses together with an evaluation, as well as actual und future innovations are presented. RESULTS: The advantage of an interposition graft is that it is unlimitedly available in every length and diameter, and furthermore, that by relatively simple revisional operations the utilization time of a vascular access can be markedly extended. Nevertheless, the patency is so far too limited. The main cause is the regularly forming, intimal hyperplasia with progressive stenosis. All available modifications have not shown decisive progress. CONCLUSIONS: In vascular access surgery, interposition grafts cannot be renounced. Higher patency rates are desirable. Technical variations can hardly solve the problem. Decisive progress is only to be expected if using pharmacologic approaches, the formation of intimal hyperplasia can reliably be inhibited.