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Increased Risk of Infection Associated with Polyurethane Dialysis Grafts
Author(s) -
Maya Ivan D.,
Weatherspoon Janice,
Young Carlton J.,
Barker Jill,
Allon Michael
Publication year - 2007
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2007.00372.x
Subject(s) - medicine , surgery , polyurethane , dialysis , thrombosis , thigh , polytetrafluoroethylene , materials science , metallurgy , composite material
Conventional polytetrafluoroethylene (PTFE) dialysis grafts cannot be cannulated for 2–3 weeks following their creation. Polyurethane grafts, made of a self‐sealing material, can be cannulated within 24 hours of implantation, representing a potential advantage in patients with limited catheter options. However, early cannulation may increase the risk of graft infection. We retrospectively queried a prospective, computerized access database to identify 31 patients receiving a polyurethane graft, and 56 date‐matched controls with a PTFE graft. Survival techniques were used to plot graft survival. Thrombosis‐free graft survival (from creation to first thrombosis or failure) was similar for polyurethane and PTFE grafts (1‐year survival, 28%, vs. 32%, p = 0.98). Cumulative graft survival (from creation to permanent failure) was also similar (1‐year survival 42% vs. 52%, p = 0.40). Finally, the cumulative risk of graft infection was 37.5% for polyurethane thigh grafts, 23% for polyurethane upper extremity grafts, 21% for PTFE thigh grafts, and 5% for PTFE upper extremity grafts ( p = 0.06 for polyurethane vs. PTFE grafts). The likelihood of thrombosis and failure is similar for polyurethane and PTFE grafts. However, polyurethane grafts may have a higher risk of infection, particularly when they are placed in the thigh. In patients with an access emergency, implantation of a polyurethane graft incurs a tradeoff between earlier cannulation and a higher risk of infection.