Indication and prospect of a newly devised ePTFE prosthesis (DTASTAT®) for hemodialysis

The indication for use and prospect of a newly devised ePTFE prosthesis (DIASTAT®) for hemodialysis were investigated. The DIASTAT® was used to 22 patients with exhausted veins due to several shunt failures and the elderly during the past 6 months. Vascular access surgery was performed from the brachial artery (end-to-side, continuous suturing) to the cubital vein (end- to-end, continuous or interrupted suturing) in a U-loop formation. As a result, there were 2 operative mortalities due to the renal failure. Although inflammation along the prosthesis was observed in 5 cases, all of them recovered without any surgical treatment. Reoperation was performed in 4 cases of continuous suturing anastomosis at the venous side. At the reoperation, the complication of thrombosis at the U-loop was revealed, and we had difficulty in performing thrombectomy from the U-loop. Therefore, interrupted suturing should be used in the anastomosis of the venous side, and the structure of the U-loop portion should be revised with a conventional ePTFE. Despite of those problems mentioned above, the puncture to the DIASTAT® was uneventful and the hemostasis of the DIASTAT® at the hemodialysis were found out to be easy and exact, because of the thickened and stratified structure of the prosthesis. Although long-term observations should be made, the DIASTAT® was revealed to be usefully indicated mainly to the cases of exhausted veins and the elderly.