Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access

Abstract

Objective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula. Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/ brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12 th month and 82% in 24 th month in SVI group while it was 88% in 12 th month and 56% in 24 th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12 th month and 93% in 24 th month for SVI group while 96% in 12 th month and 84% in 24 th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts. (Anadolu Kardiyol Derg 2014; 14: 542-6)

Biomimetic modification of poly(vinyl alcohol): Encouraging endothelialization and preventing thrombosis with antiplatelet monotherapy

“…These materials are desirable for their antithrombotic and hydrophobic properties; however, they have poor long-term outcomes with the success rate dropping from a primary patency rate of 88% at 12mths to 56% at 24mths post-implant. [2] In a recent retrospective review of femorofemoral grafts comparing ePTFE to autologous or cryopreserved tissues, the autologous femoral veins had superior patency at 1, 2, and 3yrs post-transplant compared to PTFE. [3] Moreover, ePTFE is specifically vulnerable to the loss of patency at diameters less than 6mm, as reviewed previously.…”

Vascular Access for Desperate Situations

“…Uzun et al 14 compared the clinical course of 29 saphenous vein AVF and 25 lower limb AVG showed significantly higher primary and secondary patency rate of the saphenous vein AVF. A systemic review 12 on lower limb vascular accesses reported the weighted mean primary patency rates for upper thigh AVG, mid-thigh AVG and the femoral vein transposition AVF at 12 months were 48%, 43% and 83% respectively.…”

Vascular Access and New Trends

“…The upper extremity AVF is the preferred access for hemodialysis, the duplex ultrasound identifies suitable arteries and veins for its successful creation, while early detection and intervention can save the fistula when complications occur [83]. Uzun et al [84] showed that autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due to its higher primary and secondary patency and lower complication rate and cost when compared with PTFE grafts. According to the vascular access guidelines of KDOQI, a well-functioning AVF has blood flow over 600 ml/min, with a diameter greater than 6 mm, and is lying less than 6 mm from the surface in a depth between 5 and 10 mm.…”