AUSTRALIAN MULTICENTRE EVALUATION OF A NEW POLYURETHANE VASCULAR ACCESS GRAFT

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Abstract
Background: A new three‐layered cast polyurethane vascular access graft (Thoratec® VAG) is the most recent addition to the list of materials used in the search for the perfect prosthetic graft material for haemodialysis vascular access. Despite its use in 23 countries, a clinical assessment has not been published.Methods: An independent retrospective evaluation by questionnaire was obtained for 145 implantation procedures performed by 30 surgeons.Results: Ninety‐two per cent of procedures were performed for an acute need for vascular access and 73% had prior failed vascular access surgery. Patients were hospitalized for a median of 4 days and the graft was initially used at a median of 3 days. Median follow‐up was 306 days. Thoratec® VAG had a problem‐free (primary) patency of 44.9% and a functional (secondary) patency 64.5% at 1 year. Major causes of graft loss were thrombosis (17%) and infection (11%). Intra‐operative thrombosis was the only significant risk factor for subsequent thrombosis (P =0.013). Infection was less in patients with antibiotic prophylaxis that included vancomycin (P =0.02).Conclusion: The ability to use the graft soon after surgery is a major advance for patients who urgently need reliable medium to long‐term haemodialysis access.