Interposition graft fistulas for hemodialysis.

When a radiocephalic arteriovenous (AV) fistula is not feasible for vascular access in hemodialysis, the second choice is interposition AV fistula using synthetic graft. Experience concerning patency and complications of interposition graft fistula and need for additional surgery in 49 grafts (41 patients) is reviewed. All 40 polytetrafluoroethylene (PTFE) and nine bovine grafts were placed in the forearm--22 straight between the radial artery and an antecubital vein and 27 as loops connecting the brachial artery to an antecubital vein. At the end of follow-up (mean 13, range 1-46 months), nine grafts were still in use and nine had failed, 15 patients had received a renal transplant and 15 were dead. One patient was lost to follow-up. Reoperation was necessitated by complications in 30 instances and permitted resumption of dialysis in 25. Reoperation was more common with straight than with loop graft (p less than 0.01). Interposition PTFE loop graft fistula is recommended as second choice for angioaccess, after radiocephalic fistula.