Failure of glow-discharge polymerization onto woven Dacron to improve performance of hemodialysis grafts

Diana L Farmer, Jerry Goldstone, Robert C. Lim, Linda M. Reilly

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: The ideal conduit for hemodialysis vascular access remains elusive. Autogenous fistulas and prosthetic grafts, most commonly expanded polytetrafluoroethylene (e-PTFE), have adequate long-term patency rates (60% to 80% at 1 year); however, considerable delay in their use (2 to 6 weeks) is required. The Plasma-TFE graft is a recently introduced thin-walled woven Dacron graft to which an ultrathin layer of tetrafluoroethylene is bonded through a process of glow-discharge polymerization. This process purportedly results in a graft with an internal surface of low thrombogenicity. Low thrombogenicity, combined with the healing characteristics of a woven graft, have led to claims of equivalent patency rates even when used for dialysis immediately (within 1 week) after implantation. Methods: This concept led us to use this new graft material in 19 fistulas (12 forearm and 7 arm) during a 1-year period. Results: Although early use was possible, the primary and secondary patency rate at 12 months was only 47.4%. Ten grafts required replacement, five within the first month and two in the second month. Attempts at fistula revision failed because of unsuccessful graft thrombectomy or exuberant intimal hyperplasia. Failure was not associated with early use. During the same time period, 28 PTFE grafts were implanted, with only four failures (primary patency 78.6%; secondary patency 85.7%; p = 0.028). The secondary patency rate was the same for Plasma-TFE grafts (47%) but improved to 85.7% for e-PTFE grafts (p = 0.005). Both groups were comparable with respect to age, diabetes, previous dialysis access procedures, and other comorbid conditions. Conclusions: These early results have been sufficiently disappointing that we have abandoned use of this graft approved for hemodialysis by the Food and Drug Administration and cannot recommend it for other clinical indications. Nevertheless, the concept of plasma-discharge polymerization is theoretically attractive and might be useful in future graft configurations.

Original languageEnglish (US)
Pages (from-to)570-576
Number of pages7
JournalJournal of Vascular Surgery
Volume18
Issue number4
DOIs
StatePublished - 1993

Fingerprint

Polyethylene Terephthalates
Polymerization
Renal Dialysis
Transplants
Polytetrafluoroethylene
Fistula
Dialysis
Tunica Intima
Thrombectomy
United States Food and Drug Administration
Forearm
Hyperplasia
Blood Vessels
Arm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Failure of glow-discharge polymerization onto woven Dacron to improve performance of hemodialysis grafts. / Farmer, Diana L; Goldstone, Jerry; Lim, Robert C.; Reilly, Linda M.

In: Journal of Vascular Surgery, Vol. 18, No. 4, 1993, p. 570-576.

Research output: Contribution to journalArticle

Farmer, Diana L ; Goldstone, Jerry ; Lim, Robert C. ; Reilly, Linda M. / Failure of glow-discharge polymerization onto woven Dacron to improve performance of hemodialysis grafts. In: Journal of Vascular Surgery. 1993 ; Vol. 18, No. 4. pp. 570-576.
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abstract = "Purpose: The ideal conduit for hemodialysis vascular access remains elusive. Autogenous fistulas and prosthetic grafts, most commonly expanded polytetrafluoroethylene (e-PTFE), have adequate long-term patency rates (60{\%} to 80{\%} at 1 year); however, considerable delay in their use (2 to 6 weeks) is required. The Plasma-TFE graft is a recently introduced thin-walled woven Dacron graft to which an ultrathin layer of tetrafluoroethylene is bonded through a process of glow-discharge polymerization. This process purportedly results in a graft with an internal surface of low thrombogenicity. Low thrombogenicity, combined with the healing characteristics of a woven graft, have led to claims of equivalent patency rates even when used for dialysis immediately (within 1 week) after implantation. Methods: This concept led us to use this new graft material in 19 fistulas (12 forearm and 7 arm) during a 1-year period. Results: Although early use was possible, the primary and secondary patency rate at 12 months was only 47.4{\%}. Ten grafts required replacement, five within the first month and two in the second month. Attempts at fistula revision failed because of unsuccessful graft thrombectomy or exuberant intimal hyperplasia. Failure was not associated with early use. During the same time period, 28 PTFE grafts were implanted, with only four failures (primary patency 78.6{\%}; secondary patency 85.7{\%}; p = 0.028). The secondary patency rate was the same for Plasma-TFE grafts (47{\%}) but improved to 85.7{\%} for e-PTFE grafts (p = 0.005). Both groups were comparable with respect to age, diabetes, previous dialysis access procedures, and other comorbid conditions. Conclusions: These early results have been sufficiently disappointing that we have abandoned use of this graft approved for hemodialysis by the Food and Drug Administration and cannot recommend it for other clinical indications. Nevertheless, the concept of plasma-discharge polymerization is theoretically attractive and might be useful in future graft configurations.",
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