Australian multicentre evaluation of a new polyurethane vascular access graft.
Australian multicentre evaluation of a new polyurethane vascular access graft.
复制标题
澳大利亚对新型聚氨酯血管通路移植物的多中心评估。
DOI：
10.1111/j.1445-2197.1996.tb00733.x
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
David M. A. Francis
中科院分区：
文献类型：
--
作者：
Richard D. M. Allen;E. Yuill;B. Nankivell;David M. A. Francis
背景
一种新型三层浇注聚氨酯血管通路移植物（Thoratec VAG）是用于寻找血液透析血管通路的完美假体移植物材料的材料列表中的最新添加物。尽管在23个国家使用，但尚未发表临床评估。
方法
通过问卷调查获得了30名外科医生进行的145例植入手术的独立回顾性评价。
结果
92%的手术是为了紧急需要血管通路而进行的，73%的手术之前有过血管通路手术失败的经历。患者住院时间的中位数为4天，最初使用移植物的中位数为3天。中位随访时间为306天。Thoratec VAG在1年时的无问题（一期）通畅率为44.9%，功能性（二期）通畅率为64.5%。移植物丢失的主要原因是血栓形成（17%）和感染（11%）。术中血栓形成是随后血栓形成的唯一显著风险因素（P = 0.013）。预防性使用万古霉素的患者感染较少（P = 0.02）。
结论
对于迫切需要可靠的中长期血液透析通路的患者来说，手术后立即使用移植物的能力是一个重大进步。
BACKGROUND
A new three-layered cast polyurethane vascular access graft (Thoratec VAG) is the most recent addition to the list of materials used in the search for the perfect prosthetic graft material for haemodialysis vascular access. Despite its use in 23 countries, a clinical assessment has not been published.
METHODS
An independent retrospective evaluation by questionnaire was obtained for 145 implantation procedures performed by 30 surgeons.
RESULTS
Ninety-two per cent of procedures were performed for an acute need for vascular access and 73% had prior failed vascular access surgery. Patients were hospitalized for a median of 4 days and the graft was initially used at a median of 3 days. Median follow-up was 306 days. Thoratec VAG had a problem-free (primary) patency of 44.9% and a functional (secondary) patency 64.5% at 1 year. Major causes of graft loss were thrombosis (17%) and infection (11%). Intra-operative thrombosis was the only significant risk factor for subsequent thrombosis (P = 0.013). Infection was less in patients with antibiotic prophylaxis that included vancomycin (P = 0.02).
CONCLUSION
The ability to use the graft soon after surgery is a major advance for patients who urgently need reliable medium to long-term haemodialysis access.