Long‐Term Follow‐up of 6–8 mm Brachioaxillary Polytetrafluorethylene Grafts for Hemodialysis

Tejedor, Alberto; Polo, José R.; Sanabia, Juan; Calleja, J; Gómez, Francisco Jiménez

doi:10.1111/j.1525-1594.1995.tb02280.x

Cited by 30 publications

(19 citation statements)

References 19 publications

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“…Autologous AVF are the best vascular accesses for chronic hemodialysis, offering greater primary durability and a lower number of complications [16][17][18][19]. The choice of vascular access in our protocol was based exclusively on the quality of the patient's vascular tree, regardless of age or associated pathological conditions.…”

Section: Discussionmentioning

confidence: 99%

Vascular Access for Dialysis in the Elderly

Ridao-Cano¹,

Polo²,

Pérez‐García³

et al. 2002

Blood Purif

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Aims: The aim of this study was to analyze early and late outcome of the first vascular accesses performed in the HGUGM of Madrid between 1992 and 1997, comparing the results in patients older and younger than 65 years. Methods: Retrospective study. All the vascular accesses performed in patients without previous permanent angioaccess between January 1992 and March 1997 were studied. Early failure, complication rate (patient-year of follow-up), and cumulative patency rates were analyzed. Results: The difference between grafts required in young (25%) and old patients (34%) was significant (p < 0.01). Complication rate in autologous fistulas was 0.07 per patient-year in the younger group and 0.12 per patient-year in the older (p < 0.01). Complication rate in grafts was 0.5 per patient-year in the younger group and 0.8 per patient-year in the older group (p < 0.05). There were no significant differences in patency rates for both autologous and graft accesses between patients younger or older than 65 years. Better primary patency (log-rank comparison between curves, p < 0.001), and lower complication rates (0.09 patient-year for autologous and 0.58 for grafts, p < 0.001), were observed in autologous fistulas in both groups. Conclusions: Autologous access is the best angioaccess for dialysis also in older patients and can be performed in most patients without a previous permanent access. Yet, we observed in our experience that more grafts were needed in patients older than 65 years.

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Section: Discussionmentioning

confidence: 99%

Vascular Access for Dialysis in the Elderly

Ridao-Cano¹,

Polo²,

Pérez‐García³

et al. 2002

Blood Purif

Self Cite

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“…Vascular grafts, such as commercially available poly(ethylene terephthalate) (Dacron) [ 1 ] or expanded poly(tetrafluoroethylene) grafts, [ 2 ] have achieved great clinical success in large diameter vessels. However, small‐diameter vascular grafts that are in great need for many artery bypass surgeries are still in research stage.…”

Section: Introductionmentioning

confidence: 99%

Thick PCL Fibers Improving Host Remodeling of PGS‐PCL Composite Grafts Implanted in Rat Common Carotid Arteries

Wang

Vlaminck

et al. 2020

Small

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controlled degradation in vivo provides a promising alternative to these nondegradable synthetic grafts. [4] Soon after implantation, the grafts will induce inflammation. As inflammation resolves and scaffold degrades, autogenous vascular cells are recruited, and neo-tissues grow in. After full degradation of graft scaffolds, artery-like tissues could then form in situ. Central to this transformation is how inflammation changes over time and how host populates the porous grafts with vascular endothelial and smooth muscle cells (SMCs). Macrophages play an important role during this process. [5] Our data reveal that not only is macrophage essential to the inflammation, but they also directly participate in the "vitalization" of the graft, that is, turning the acellular graft into a living vascular conduit. Macrophages exhibit continuum phenotypes with two extremes: M1, the classically activated one, which is pro-inflammatory; and M2, the alternatively activated one, which is anti-inflammatory and generally promotes regeneration. Transition of macrophages into M2 phenotype has been shown to promote vascular graft remodeling. [4,6] In addition to switching between M1/M2 states, there is evidence that monocytes/macrophages in peripheral blood can transdifferentiate into endothelial cells (ECs) or endothelial progenitor cells. [7] A recent study shows that circulating monocytes participate in endothelialization of vascular grafts by trans-differentiation into ECs. [8] Meanwhile, macrophages have been reported to express myofibroblast markers and deposit collagens. [9] The plasticity of monocytes/macrophages endow them the potential to transdifferentiate into ECs, SMCs, and fibroblast cells to regenerate blood vessels in situ. However, there remains little evidence that monocytes/macrophages could contribute to vascular graft remodeling in vivo via trans-differentiation into vascular cells. Porous poly(glycerol sebacate) (PGS) conduits sheathed with electrospun polycaprolactone (PCL) have good performances in arterial circulation in abdominal aortas [10] and carotid arteries in rats. [10c,11] In addition, the composite grafts show a near complete host remodeling with minimal graft materials left after 3 months in vivo. [12] However, a major issue associated with graft remodeling in vivo is limited neo-tissue formation inside PCL layers. The possible reason for this is small pores of PCL sheaths that inhibit cell infiltration and migration. Similar phenomena have Vasculopathy and the consequential ischemia are major medical challenges. Grafting is an effective treatment to vascular occlusion. However, autologous grafting, despite scarcity, is the only choice for small diameter blood vessels. Synthetic grafts can fill the gap if they can work satisfactorily in arterial circulation. Electrospun polycaprolactone (PCL) sheathed porous poly(glycerol sebacate) (PGS) vascular grafts have good performances in arterial circulation in abdominal aortas and carotid arteries in rats. However, a major issue associated with the graft r...

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“…Taking into consideration all of the above mentioned studies and results, the brachiobasilic AVF still remains a better option than the graft fistulas. Literature data show a better patency for brachiobasilic AVF than for AVFs using grafts due to the higher complication rates such as thrombosis and infection for the grafts (20)(21)(22). A 1-year patency rate of 54%-90% is achievable and in specialized centers it is between 80% and 90%.…”

Section: Discussionmentioning

confidence: 99%