Morphologic assessment of ePTFE graft wall damage following hemodialysis needle punctures

Repeated needle trauma to grafts used for chronic hemodialysis may result in loss of graft integrity and aneurysmal formation. The gross and scanning electron microscope observations of the virgin expanded polytetrafluorethylene graft (ePTFE) material following repeated needle punctures are presented. Understanding how the normal structure of the ePTFE graft can be affected, particularly by larger diameter needles, underlines the effect and importance of needle puncture technique. In assuming that aneurysm related to needle punctures is the only evolutive complication of the vascular access, this analysis showed that the half life of an ePTFE prosthesis which was 6 mm in diameter and 25 cm in length was reached after about 1512 punctures using the 1.8‐mm diameter hemodialysis needle, 1111 punctures with the 2.1‐mm diameter needle or 784 punctures with the 2.5‐mm diameter needle.