Duplex ultrasound characteristics of 4-7-mm tapered versus 6-mm PTFE graft AV fistulas for hemodialysis vascular access

R. Dammers, A. J. Rühl, K. P.M. Pouls, J. H.M. Tordoir*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Prosthetic arteriovenous fistulas (AVFs) for hemodialysis have a high incidence of thrombotic occlusions with ensuing graft failure. We hypothesized that 4-7-mm tapered polytetrafluoroethylene (PTFE) grafts perform better hemodynamically than 6-mm PTFE prostheses, showing improved patency rates. Therefore, we performed a Duplex ultrasound study of 4-7-mm versus 6-mm loop PTFE AVFs in the forearm. Blood flow measurements, peak systolic velocities (PSVs), and stenosis detection were performed at 1, 3, and 6 months postoperatively. Clinical data were obtained for analysis and patency rates were calculated. Of the 60 patients included, 27 were randomized for 4-7-mm stretch ePTFE grafts. Although patencies were similar for both groups, the incidence of thrombosis was higher in the tapered grafts (0.46/patient year versus 1.07/patient year, P < .05). PSVs at the venous anastomosis were lower at 1 and 3 months (198 versus 130, P < .05; 176 versus 111, P < .05) and stenoses were significantly reduced at 3 months in the tapered grafts (50 versus 9%, P < .05). The hemodynamic performance of 4-7-mm PTFE grafts is better compared with 6-mm grafts, causing a decrease in graft and anastomotic shear stress, leading to reduced stenoses at the venous anastomosis. However, no differences in patency rates are observed.

Original languageEnglish
Pages (from-to)11-16
Number of pages6
JournalJournal of Vascular Technology
Volume25
Issue number1
Publication statusPublished - 2001
Externally publishedYes

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