Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Vasc Surg. 2011 Jun;53(6):1640-8. doi: 10.1016/j.jvs.2011.02.008.
Many patients on hemodialysis do not have adequate anatomy for native arteriovenous fistulas. In these patients, synthetic conduits remain an alternative option for permanent hemodialysis access. We sought to compare the standard cuffed expanded polytetrafluoroethylene (ePTFE) graft with the bovine carotid artery (BCA) graft.
This was a prospective, randomized controlled trial that was set in an academic medical center. We enrolled 26 patients in the BCA group and 27 patients in the ePTFE group. Primary, assisted primary, and secondary patency were calculated using the Kaplan-Meier method. Complications were monitored and are reported.
Although there was no significant difference in secondary patency rates, primary and assisted primary patency rates were significantly higher in BCA than in the ePTFE grafts (60.5% vs 10.1% and 60.5% vs 20.8% at 1 year, respectively). The BCA graft survival advantage was most profound in the upper arm grafts with significantly higher primary and assisted patency rates (P < .0001 and .0005, respectively). The total number of interventions (upper arm grafts) and total number of angioplasties (overall and upper arm) required to maintain patency were significantly fewer in the BCA group. The most common complication was graft thrombosis which occurred 0.34 ± 0.09 times per patient year in the BCA group compared to 0.77 ± 0.16 times per patient year in the ePTFE group, P = .01.
The BCA graft is an excellent option for patients on hemodialysis that are not suitable for native arteriovenous fistulas, as these grafts required fewer interventions than the ePTFE grafts to maintain patency.
许多接受血液透析的患者不具备合适的自体动静脉瘘解剖结构。在这些患者中，合成移植物仍然是永久性血液透析通路的另一种选择。我们旨在比较标准带袖口膨体聚四氟乙烯（ePTFE）移植物与牛颈动脉（BCA）移植物。
这是一项在学术医疗中心进行的前瞻性、随机对照试验。我们将 26 例患者纳入 BCA 组，27 例患者纳入 ePTFE 组。使用 Kaplan-Meier 方法计算原发性、辅助原发性和继发性通畅率。监测并报告并发症。
尽管继发性通畅率无显著差异，但 BCA 组的原发性和辅助原发性通畅率显著高于 ePTFE 移植物（分别为 60.5%比 10.1%和 60.5%比 20.8%，1 年时）。BCA 移植物的生存优势在肱动脉移植物中最为明显，原发性和辅助通畅率显著更高（P<0.0001 和 P<0.0005）。为保持通畅而需要进行的干预总次数（肱动脉移植物）和需要进行的血管成形术总次数（整体和肱动脉）在 BCA 组中明显更少。最常见的并发症是移植物血栓形成，BCA 组患者每年发生 0.34±0.09 次，而 ePTFE 组为 0.77±0.16 次，P=0.01。
对于不适合自体动静脉瘘的血液透析患者，BCA 移植物是一个极好的选择，因为与 ePTFE 移植物相比，这些移植物需要更少的干预来保持通畅。
