A PROSPECTIVE EVALUATION OF PLASMA-TFE AND EXPANDED PTFE GRAFTS FOR ROUTINE AND EARLY USE AS VASCULAR ACCESS DURING HEMODIALYSIS
A PROSPECTIVE EVALUATION OF PLASMA-TFE AND EXPANDED PTFE GRAFTS FOR ROUTINE AND EARLY USE AS VASCULAR ACCESS DURING HEMODIALYSIS
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DOI：
10.1097/00000658-199211000-00012
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发表时间：
1992-11-01
影响因子：
9
通讯作者：
SHELTON, L
中科院分区：
文献类型：
--
作者：
HELLING, TS;NELSON, PW;SHELTON, L
在终末期肾脏疾病患者中，使用假体移植物作为慢性血液透析的血管通路是经常必要的。最常见的是，由于易于操作，组织惰性和可接受的长期通畅，已采用膨胀聚四氟乙烯（e-PTFE）。然而，延迟使用以允许组织向内生长，通常需要放置临时访问装置。作者在一项前瞻性随机试验（plasma - tfe VA）中评估了一种新材料，血浆聚合编织涤纶血浆- tfe，以比较与e-PTFE移植物的临床行为，并且我们在另一组患者（plasma - tfe AVA）中使用血浆- tfe移植物作为早期使用（植入后1周内）。采用前瞻性随机方式，在19例患者中植入21个血浆- tfe移植物，在17例患者中植入19个e-PTFE移植物。此外，31例血浆- tfe移植物被植入31名非随机患者的早期准入。血浆tfe - VA和e-PTFE在12个月时的初级通畅率相等（0.471和0.556）。当纳入血浆- tfe AVA原发性通畅（0.621）时，比较无统计学意义（p = 0.50）。同样，三组间的二次通畅率也没有差异（12个月累积专利比例：血浆- tfe VA 0.403, e-PTFE 0.658，血浆- tfe AVA 0.510）。然而，在考虑移植物血栓形成后翻修后的通畅性时，血浆- tfe移植物（VA和AVA）的表现明显比e-PTFE移植物差（p = 0.027）。血浆tfe （VA和AVA）与e-PTFE在移植物感染、伤口感染、手臂水肿、使用后血肿、远端肢体缺血发生率方面无统计学差异。作者得出结论，即使早期使用，血浆tfe在原发性和继发性通畅以及非血栓性并发症方面也优于e-PTFE。然而，在移植物血栓形成后，血浆- ptfe的表现不如e-PTFE。
The use of prosthetic grafts as vascular access for chronic hemodialysis is frequently necessary in patients with end-stage renal disease. Most commonly, expanded polytetrafluoroethylene (e-PTFE) has been employed because of ease of handling, tissue inertness, and acceptable long-term patency. Delay in use to allow for tissue ingrowth, however, has often required placement of temporary access devices. The authors have undertaken evaluation of a new material, plasma polymerized woven dacron Plasma-TFE, in a prospective randomized trial (Plasma-TFE VA) to compare clinical behavior against e-PTFE grafts, and we have used the Plasma-TFE grafts in an additional group of patients (Plasma-TFE AVA) as early access (within 1 week of implantation). Twenty-one Plasma-TFE grafts were implanted in 19 patients and 19 e-PTFE grafts were implanted in 17 patients in a prospective randomized fashion. Additionally, 31 Plasma-TFE grafts were implanted in 31 nonrandomized patients for early access. Primary patency rates in Plasma-TFE VA and e-PTFE grafts were equivalent at 12 months (0.471 and 0.556). When Plasma-TFE AVA primary patency was included (0.621), comparisons were not statistically significant (p = 0.50). Similarly, secondary patency rates among the three groups did not differ (cumulative proportion patent at 12 months: Plasma-TFE VA 0.403, e-PTFE 0.658, Plasma-TFE AVA 0.510). In considering after-revision patency after graft thrombosis, however, the Plasma-TFE grafts (both VA and AVA) performed significantly more poorly (p = 0.027) than e-PTFE grafts. Incidence of graft infection, wound infection, arm edema, hematoma from use, and occurrence of distal limb ischemia between Plasma-TFE (VA and AVA) and e-PTFE did not differ statistically. The authors conclude that Plasma-TFE compares favorably to e-PTFE with respect to primary and secondary patency and nonthrombotic complications, even with early use. Plasma-TFE does not perform as well as e-PTFE, however, after graft thrombosis.