Alternative Graft Materials for Hemodialysis Access

Since the initial description of the arteriovenous (AV) fistula, autogenous access has been the procedure of choice for chronic hemodialysis. Recently established National Kidney Foundation Dialysis Outcome and Quality Initiative guidelines have validated the superiority of arteriovenous fistulas over AV grafts but have also addressed the fact that a significant percentage of the growing dialysis population does not have veins suitable for primary AV fistulas. Recent advances in forearm, upper arm, and femoral venous transpositions have facilitated the performance of increased numbers of autogenous access procedures. Nevertheless, substantial numbers of patients on chronic hemodialysis require prosthetic AV grafts. Since early reports describing hemodialysis access using expanded polytetrafluoroethylene, surgical results with prosthetic graft materials have remained suboptimal. Modifications in polytetrafluoroethylene grafts and the recent development of alternative graft materials for hemodialysis access have yielded encouraging early results in efforts to improve patency of AV grafts. We will review currently available graft materials and recent developments in an ongoing effort to improve the results with prosthetic and biologic hemodialysis access conduits.