Long-term follow-up of 6-8 mm brachioaxillary polytetrafluorethylene grafts for hemodialysis.

Eight millimeter expanded polytetrafluoroethylene (e-PTFE) grafts, tapered to 6 mm at the arterial site, are used by our group in the upper arm in order to avoid midgraft stenosis observed with other graft sizes. Long-term results (1-12 years) on 157 6-8 mm brachioaxillary e-PTFE grafts (Gore-Tex) are analyzed. Early failure was found in 4 grafts (2.5%). The rate of late complications was 0.37 episodes per graft-year. Steal syndrome, found in 4 cases (2.5%), was successfully treated in 3 cases by graft banding. Neither midgraft nor arterial anastomotic stenosis was observed in the 63 grafts requiring surgical thrombectomy or fistulography. The primary patency rates were 73%, 53%, and 41% at 1, 3, and 5 years, respectively. The secondary patency rates were 91%, 80%, and 72% at 1, 3, and 5 years, respectively. Comparison between both curves by the log rank test was significant (p < 0.001) expressing the efficiency of rescue surgery. We conclude that a 6-8 mm graft can be successfully used for dialysis in the brachioaxillary position.