Illustration of a hybrid vascular graft integrated into the circulatory system.

Dialysis Access Innovation: How Hybrid Grafts Offer New Hope for Patients with Limited Options

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"A closer look at how polytetrafluoroethylene hybrid vascular grafts with preloaded nitinol stents are improving outcomes for hemodialysis patients with complex venous challenges."

Patients with end-stage renal disease (ESRD) often require hemodialysis, a procedure that necessitates reliable vascular access for blood purification. Creating and maintaining this access can be challenging, especially when patients have limited venous outflow or complex anatomical issues. Traditionally, arteriovenous fistulas (AVFs) using a patient's own veins are preferred, but many individuals eventually need arteriovenous grafts (AVGs) as their venous anatomy becomes depleted.

AVGs, while effective, are prone to complications such as stenotic lesions—narrowing of the blood vessels—particularly at the point where the graft connects to the vein. These stenoses can lead to thrombosis (clotting) and make future access more difficult to create. The development of stenotic lesions is often triggered by endothelial injury from shear stress and turbulent blood flow, resulting in neointimal hyperplasia, an excessive growth of cells in the vessel wall.

To combat these challenges, innovative solutions have emerged, such as the Gore hybrid vascular graft. This graft combines a polytetrafluoroethylene (PTFE) graft with a nitinol stent incorporated into the venous outflow end. The stent-graft is designed to be deployed within the outflow vein in a sutureless, straight configuration, aiming to reduce turbulent flow and subsequent neointimal hyperplasia. A recent study has evaluated the clinical outcomes, patency, and complications associated with this hybrid vascular graft in hemodialysis access.

What are the benefits of Hybrid Vascular Grafts for Dialysis Access?

Illustration of a hybrid vascular graft integrated into the circulatory system.

A retrospective study conducted at two academic centers between July 2013 and December 2016 examined the outcomes of patients who underwent surgical AVG creation using the Gore hybrid vascular graft. The study focused on patients with limited venous outflow or challenging anatomy, assessing graft patency, function, and the need for subsequent percutaneous interventions. Forty-six patients were included, with a mean age of 63 ± 13 years; 30 were females (65.2%) and 16 were males (34.8%).

The most common reasons for using a hybrid vascular graft were limited surgical accessibility and/or revision of existing AVGs due to severe stenotic lesions at the venous outflow, accounting for 72% of cases. The study revealed the following patency rates:

One-year primary unassisted patency: 44 ± 8%
One-year primary assisted patency: 54 ± 8%
One-year secondary patency: 66 ± 8%

To maintain graft function and patency, approximately one percutaneous intervention per graft was needed each year. These interventions were comparable to those required for traditional AVGs, suggesting that the hybrid graft offers a viable alternative without increasing the intervention burden. Access created with the hybrid vascular graft in a brachial-axillary configuration—connecting the brachial artery to the axillary vein—is an acceptable option for patients with limited venous outflow reserve and challenging anatomy.

The Future of Hemodialysis Access

The findings from this study indicate that hybrid vascular grafts offer a promising solution for hemodialysis patients with limited venous outflow and challenging anatomy. By providing comparable patency rates and intervention needs to traditional AVGs, these grafts expand the options available to clinicians and improve the quality of life for patients undergoing hemodialysis. As research continues, further refinements in graft technology and surgical techniques may lead to even better outcomes, ensuring reliable and durable vascular access for all patients in need.

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This article is based on research published under:

DOI-LINK: 10.1016/j.avsg.2018.06.029, Alternate LINK

Title: Outcomes Of A Polytetrafluoroethylene Hybrid Vascular Graft With Preloaded Nitinol Stent At The Venous Outflow For Dialysis Vascular Access

Subject: Cardiology and Cardiovascular Medicine

Journal: Annals of Vascular Surgery

Publisher: Elsevier BV

Authors: Peiman Habibollahi, Mark P. Mantell, Trish Rosenberry, David B. Leeser, Timothy W.I. Clark

Published: 2019-02-01

Everything You Need To Know

What are hybrid vascular grafts and how do they help hemodialysis patients?

Hybrid vascular grafts, particularly those using polytetrafluoroethylene (PTFE) combined with a nitinol stent, offer several benefits for hemodialysis access. They are designed to address challenges associated with limited venous outflow and complex anatomical issues. The stent-graft aims to reduce turbulent blood flow and subsequent neointimal hyperplasia, a major cause of graft failure. This can improve patency rates, meaning the graft remains open and functional for a longer period. For patients, this means fewer interventions to maintain access and an improved quality of life. The hybrid grafts provide an alternative when creating arteriovenous fistulas (AVFs) is not feasible.

Why are stenotic lesions a problem with arteriovenous grafts, and how do hybrid grafts address this issue?

Arteriovenous grafts (AVGs) are prone to stenotic lesions, which are narrowings in the blood vessels, particularly where the graft connects to the vein. These stenoses can lead to thrombosis, or clotting, making future access more difficult. Stenotic lesions are often caused by endothelial injury from shear stress and turbulent blood flow, resulting in neointimal hyperplasia. The development of stenotic lesions is a common cause of AVG failure, which is why innovations like the Gore hybrid vascular graft are important. This graft is designed to reduce turbulence and subsequent neointimal hyperplasia, which helps maintain graft patency.

What do you mean by 'patency rates' when talking about vascular access grafts?

Patency rates refer to how long a vascular access graft remains open and functional without significant intervention. There are different types of patency rates: primary unassisted patency (how long the graft works without any procedures to maintain it), primary assisted patency (how long the graft works with interventions like angioplasty), and secondary patency (how long the graft can be salvaged and made functional again with more extensive interventions). Higher patency rates mean fewer interventions, reduced complications, and better long-term outcomes for hemodialysis patients. In the study, the one-year primary unassisted patency was 44 ± 8%, the one-year primary assisted patency was 54 ± 8%, and the one-year secondary patency was 66 ± 8%.

What are percutaneous interventions and why are they relevant to dialysis access?

Percutaneous interventions are minimally invasive procedures performed to maintain the function and patency of vascular access grafts. These interventions often involve angioplasty, where a balloon is used to widen narrowed sections of the graft caused by stenotic lesions. The frequency of these interventions is an important factor in evaluating the success of a particular type of graft. While the hybrid vascular graft requires approximately one percutaneous intervention per graft per year, this rate is comparable to traditional AVGs, indicating that the hybrid graft offers a viable alternative without increasing the intervention burden. This is significant because fewer interventions translate to a better quality of life for hemodialysis patients.

What does it mean when a hybrid vascular graft is placed in a 'brachial-axillary configuration'?

A brachial-axillary configuration involves connecting the brachial artery to the axillary vein using a vascular access graft. This approach is particularly useful for patients with limited venous outflow reserve and challenging anatomy, where creating access in other locations may not be feasible. Using the hybrid vascular graft in a brachial-axillary configuration can provide a reliable and durable vascular access option for these patients, ensuring they can receive the hemodialysis treatments they need. This configuration expands the possibilities for patients who might otherwise have limited options.