Experience with an Alternate Prosthesis for Chronic Vascular Access

Abstract

Although chronic hemodialysis has been employed for more than twenty-five years, the perfect ap proach to chronic vascular access has yet to be realized. The standard ra dial-cephalic fistulae, although suc cessful in a majority of patients, may not provide suitable vascular access. Their failure may be due to paucity of forearm veins, patient's obesity, or lack of patent veins.

Among the alternatives is the car bon transcutaneous access device (CTAD). This paper discusses the four-year experience of one surgeon with the CTAD.

Over a four-year period, the CTAD was utilized in 13 selected pa tients. The selection of these patients was based on the failure of many other access techniques. Prior to CTAD, the patients had had from two to fourteen access procedures. The CTADs have provided four to fifty months of satisfactory access.

Of the 13 patients, 6 have expired with functional CTADS. Four pa tients have had the CTADs removed. One was removed at thirty-two months when it was decided to con vert this patient to peritoneal dialysis after satisfactory access with the CTAD. Another was removed after four months in a patient who opted to switch to peritoneal dialysis. One was removed at nineteen months after failed function, and one was removed after eight months because of Can dida sepsis.

The other 3 patients are living with functional CTADs in use, the longest being in operation fifty months.

The major problem has been the formation of a ball-valve thrombus at the base of the port. A nonoperative approach has been successful in re moval of this thrombus.

The selection of site for the CTAD is of importance for patient conven ience and for longevity of function. The experience in this pilot group of patients with the CTAD followed up to fifty months on dialysis has proved the CTAD to be a significant tool in the armamentarium of the vascular access surgeon.