Massimiliano Gessaroli, Silvia Massini and Salvatore Tarantini
Purpose: The aim of this study was to value the performance of a modified commercially available longitudinal stretch expanded polytetrafluoroethylene (ePTFE) vascular Gore (W.L.Gore & Associates, Flagstaff, Arizona) graft (either Intering or heparin-bonded Propaten) with an added handmade compliant ePTFE cuff in arterovenous grafts (AVG) for hemodialysis, valuing the primary patency rate at 12 months.
Methods: 25 patients consecutively underwent AVG’s with 8 modified stretch Intering grafts (mIG) and 17 modified stretch Propaten grafts (mPG). The modified grafts were obtained during surgical procedures assembling to the major host of a tapered stretch (longitudinal) ePTFE hemodialysis Gore graft, an hand-made cuff of the same material but turned at 90° to obtain a radial stretch (previously reported in experimental animal study). Primary patency rate of these modified grafts was evaluated at 12 months and the results compared with our previous experience: 60 consecutive cases with the same unmodified grafts (53 Intering and 7 Propaten grafts).
Results: In 25 patients with the modified grafts the cumulative primary patency rate of arterovenous grafts at 12 months was 91.3% with a one year mortality of 12%, while in our previous consecutive experience, primary patency and mortality rates in 60 patients with unmodified grafts were 60.4% and 11.7%, respectively. Valuing the overall combined primary patency rate of arterovenous grafts of the two groups (modified vs. unmodified grafts) with Kaplan Meyer curve and Logrank test the difference was statistically significant: Chi square=7.115, p=0.007. On the contrary analyzing the two subgroups with modified grafts ( mIG vs. mPG) primary patency rates were 100% in both at 6 months, 87.5% and 94.1%, respectively at 12 months (statistically not significant).
Conclusions: The preliminary resuts of modified stretch ePTFE vascular grafts with compliant ePTFE cuff significantly seem to improve the vascular access graft patency, independently by the used stretch graft (heparinbonded or not).