Determinants of successful synthetic hemodialysis vascular access graft placement
Determinants of successful synthetic hemodialysis vascular access graft placement
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DOI：
10.1067/mva.2003.257
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发表时间：
2003-05-01
影响因子：
4.3
通讯作者：
Feldman, HI
中科院分区：
文献类型：
--
作者：
Rosas, SE;Joffe, M;Feldman, HI
目的：合成血管移植物是美国最常见的永久性透析移植物，其发病率高，费用高。在接受血液透析并接受新合成血管移植物的患者的队列研究中，详细的术中操作数据被检查为移植物功能障碍和失败的预测因素。一项前瞻性队列研究对接受血液透析的患者进行了随访，这些患者接受了超过4（1）年的合成（聚四氟乙烯）移植物放置，直至移植物不再可用、进行肾移植、患者死亡或研究结束。主要的分析方法是Kaplan-Meier法，用于计算一期和二期移植物通畅率的生存函数，以及考克斯比例风险回归，用于建立预测变量和移植物失败之间的模型。在入组研究的284例患者中，172例患者（61%）在随访期间至少发生了1起移植物相关事件，即暂时性移植物功能障碍或移植物衰竭。三年累积移植物存活率为54%（95%置信区间，45%-62%）。使用比例风险分析，跛行史（率比[RR]，2.14 [范围，0.97-4.73]; P= 0.06），既往永久性移植物数量（1个移植物：RR，1.49 [范围，0.88-2.51]; 2个或更多移植物：RR，2.85 [范围，1.43-5.69]; P=.01），手术时透析依赖性（RF，2.96 [范围，1.23-7.12]; P= 0.02）和在构建移植物时使用动脉夹（RR，2.32 [范围，1.14-4.73]; P= 0.02）与较低的生存率相关，即使考虑了病史。移植物材料类型，即Gore-Tex与其他材料（RR，0.28 [范围，0.16-0.50]; P
Objective: Synthetic vascular grafts, the most common type of permanent dialysis graft used in the United States, are associated with great morbidity and expense. In this cohort study of patients undergoing hemodialysis and receiving a new synthetic vascular graft, detailed intraoperative procedural data were examined as predictors of graft dysfunction and failure.Methods. A prospective cohort study of patients receiving hemodialysis who had undergone synthetic (polytetrafluoroethylene) graft placement over 4(1)/years were followed up until either the graft was no longer usable, kidney transplantation was performed, the patient died, or the study ended. The principal methods of analysis used were the Kaplan-Meier method, to compute survival function for primary and secondary graft patency, and Cox proportional hazards regression, to model associations between predictor variables and graft failure.Results. Of 284 patients enrolled in the study, 172 patients (61%) had at least one graft-related event, ie, temporary graft dysfunction or graft failure, during follow-up. Three-year cumulative graft survival was 54% (95% confidence interval, 45%-62%). Using proportional hazards analysis, history of claudication (rate ratio [RR], 2.14 [range, 0.97-4.73]; P=.06), number of previous permanent grafts (1 graft: RR, 1.49 [range, 0.88-2.51]; 2 or more grafts: RR, 2.85 [range, 1.43-5.69]; P=.01), dialysis dependency at surgery (RF, 2.96 [range, 1.23-7.12]; P=.02), and use of arterial clamps in construction of the graft (RR, 2.32 [range, 1.14-4.73]; P=.02) were associated with lower survival, even after accounting for medical history. Type of graft material, ie, Gore-Tex versus other material (RR, 0.28 [range, 0.16-0.50]; P