Ladenheim Eric D, Lum Craig, Chadwick Nathan, Agrawal Siddartha
Ladenheim Dialysis Access Centers, Fresno, California 93710, USA.
Semin Dial. 2012 Nov-Dec;25(6):689-92. doi: 10.1111/j.1525-139X.2012.01085.x. Epub 2012 Jun 11.
We reviewed the effectiveness of a gelatin-coated polytetrafluoroethylene (PTFE) graft designed to reduce suture line bleeding and graft weeping. Twenty-nine adults with end-stage renal disease underwent implantation the graft (n = 30) in the arm. All had preoperative ultrasound vascular mapping to assess their options for an autogenous arteriovenous fistula and patients with a history of prior central venous devices or sternotomy underwent contrast venography. A 4- to 7-mm tapered graft (n = 10) was used if the inflow artery was <4.0 mm in diameter, and a 6-mm straight graft (n = 20) was used if the artery was ≥4.0 mm. Intraoperative volume flows were measured by duplex methodology. Precautions to prevent ultrafiltration and seroma development were taken. Eleven clinically significant seromas were detected in 30 sealed PTFE grafts (36.7%), 10 in the 6-mm grafts (50%), and 1 in a 4- to 7-mm graft (10%), a significant difference between graft types. There were no significant differences in flow between the graft types and between grafts with seromas versus no seromas. Five grafts were explanted and one was ligated, resulting in cannulation delays from 2 to 4 months. We conclude that the gelatin-sealed PTFE vascular graft is not the ideal prosthesis for hemodialysis access.
我们评估了一种旨在减少缝合线出血和移植物渗液的明胶涂层聚四氟乙烯（PTFE）移植物的有效性。29例终末期肾病成人患者在手臂植入了该移植物（n = 30）。所有患者术前均接受超声血管造影以评估自体动静脉内瘘的选择，有中心静脉置管或胸骨切开术史的患者接受了静脉造影。如果流入动脉直径<4.0 mm，则使用4至7 mm的锥形移植物（n = 10）；如果动脉直径≥4.0 mm，则使用6 mm的直形移植物（n = 20）。术中通过双功超声方法测量血流量。采取了预防超滤和血清肿形成的措施。在30个密封的PTFE移植物中检测到11例具有临床意义的血清肿（36.7%），其中6 mm移植物中有10例（50%），4至7 mm移植物中有1例（10%），移植物类型之间存在显著差异。移植物类型之间以及有血清肿与无血清肿的移植物之间的血流量无显著差异。5个移植物被取出，1个被结扎，导致插管延迟2至4个月。我们得出结论，明胶密封的PTFE血管移植物不是用于血液透析通路的理想假体。
