An Outcomes Comparison of Native Arteriovenous Fistulae, Polytetrafluorethylene Grafts, and Cryopreserved Vein Allografts
An Outcomes Comparison of Native Arteriovenous Fistulae, Polytetrafluorethylene Grafts, and Cryopreserved Vein Allografts
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DOI：
10.1016/j.avsg.2015.07.009
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发表时间：
2015-11-01
影响因子：
1.5
通讯作者：
Brown, Matthew G.
中科院分区：
文献类型：
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作者：
Jadlowiec, Caroline C.;Lavallee, Matthew;Brown, Matthew G.
背景资料：尽管有近20年的尸体静脉经验，但关于尸体静脉在血液透析中的作用，特别是关于结局和通畅性的可用数据仍然很少。根据我们自己的经验，观察表明，尸体静脉移植（CVGs）提供了良好的结局，特别是在复发性通路失败的患者中。因此，本研究的目的是比较研究通畅性，访问相关的结果，并接受放置动静脉瘘（AVF），聚四氟乙烯（PTFE）移植物，和CVGs.Methods的患者的生存率：这是一个单一的机构11年的回顾性病例系列评价谁经历了创建AVF，PTFE移植物，和CVGs的血液透析通路的210例患者的结果。AVF（n = 70）和动静脉移植物（AVG; n = 70）组的患者与CVG（n = 70）组的患者按年龄、性别和入路位置进行匹配。所有组的术后终点包括主要和辅助通畅率，原因的访问放弃，和survival.Results：患者的年龄（P = 0.8707），性别（P = 0.6958）和访问位置匹配，组间无显着差异。AVF在30天、1年（64.3%，P < 0.0001）和2年（54.3%，P = 0.0091）时的一期通畅率上级AVG和CVG。与AVF和CVG组相比，AVG组在30天（84.3%，P = 0.0009）、1年（50.0%，P < 0.0001）和2年（32.9%，P = 0.0001）时的通畅率降低。总体而言，AVF在所有时间点的通畅率最高，其次分别是CVG和AVG。AVF组和CVG组在30天（98.6% vs. 97.1%，P = 1.0000）、1年（81.4% vs. 78.6%，P = 0.6749）和2年（68.6% vs. 51.4%，P = 0.0573）时的二期通畅率无显著差异。AVG患者的生存率（年）下降后，建立通路相比AVF和CVG groups.Conclusions（P = 0.0003）：我们的研究结果进一步支持使用尸体静脉血液透析通路手术。如本比较研究所示，CVG能够在通畅性、通路寿命和患者生存率方面提供有利的结果。这些当前结局表明，尸体静脉是血液透析通路手术中PTFE的可持续替代品，因此应考虑用于难以进入的患者。
Background: Despite almost 2 decades of experience with cadaveric vein, there remains a paucity of available data regarding the role of cadaveric vein in hemodialysis, specifically with regard to outcomes and patency. Observations from our own experience have suggested that cadaveric vein grafts (CVGs) provide good outcomes, particularly in patients with recurrent access failure. Accordingly, this study aims to comparatively examine patency, access-related outcomes, and survival in patients undergoing placement of arteriovenous fistulae (AVF), polytetrafluorethylene (PTFE) grafts, and CVGs.Methods: This is a single institution 11-year retrospective case series evaluating the outcomes of 210 patients who underwent creation of AVF, PTFE grafts, and CVGs for hemodialysis access. Patients in the AVF (n = 70) and arteriovenous graft (AVG; n = 70) groups were matched to the CVG (n = 70) group by age, gender, and access location. Postoperative end points for all groups included primary and assisted patency, cause of access abandonment, and survival.Results: Patients were matched for age (P = 0.8707), gender (P = 0.6958), and access location and no significant differences existed between groups. AVF showed superior primary patency at 30 days, 1 year (64.3%, P < 0.0001) and 2 years (54.3%, P = 0.0091) in comparison to both AVG and CVG. AVG had reduced patency at 30 days (84.3%, P = 0.0009), 1 year (50.0%, P < 0.0001), and 2 years (32.9%, P = 0.0001) in comparison to AVF and CVG groups. Overall, AVF had the highest patency at all-time points followed, respectively by CVG and AVG. No significant difference existed between AVF and CVG groups with regard to secondary patency at 30 days (98.6% vs. 97.1%, P = 1.0000), 1 year (81.4% vs. 78.6%, P = 0.6749), and 2 years (68.6% vs. 51.4%, P = 0.0573). AVG patients had decreased survival (years) after access creation in comparison to AVF and CVG groups (P = 0.0003).Conclusions: Our findings lend further support to the use of cadaveric vein for hemodialysis access surgery. As demonstrated through this comparative study, CVGs are capable of providing favorable results with regard to patency, access longevity, and patient survival. These current outcomes indicate that cadaveric vein is a sustainable alternative to PTFE for hemodialysis access surgery and should be accordingly considered for difficult access patients.