Polytetrafluoroethylene (PTFE) grafts were inserted in the thigh of 14 children (7 boys and 7 girls, age 12 +/- 1.8 years) who were undergoing chronic hemodialysis for endstage renal disease. Removal of grafts was necessary in three patients within three months of implantation. In a fourth case it was indicated in the fifteenth month. In two cases thrombectomy was necessary. Echocardiography was performed in 10 patients before and three and 12 months after surgery. Cardiac performance followed by echocardiography did not change after one year. After two years the survival of grafts was 71%. It appears that synthetic grafts offer advantages for pediatric hemodialysis patients with arteriovenous fistula failure. On the other hand, this technique entails serious risks.