Pineda Danielle M, Dougherty Matthew J, Wismer Michael C, Carroll Chelsea, Tyagi Samuel, Troutman Douglas A, Calligaro Keith D
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
J Vasc Surg. 2017 Jun;65(6):1729-1734. doi: 10.1016/j.jvs.2016.12.109. Epub 2017 Mar 30.
Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency.
We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method.
For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency (P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or <30 (P = .85, P = .54). Patients who had a BCA graft as their first access attempt had a higher primary and primary assisted patency than that of patients who had the graft placed after prior access failure (P = .039, P = .024).
This represents the largest published series of BCA grafts for arteriovenous grafts in the modern era. The primary patency of BCA grafts in this series was lower than that reported in a smaller randomized study. However, primary assisted and secondary patency were similar. Infection rates in this series appear to be somewhat lower than polytetrafluoroethylene infection rates reported in the literature. BCA grafts are a satisfactory alternative to expanded polytetrafluoroethylene for hemodialysis access, but larger controlled studies are needed to determine whether superior primary patency previously reported is a reproducible finding.
牛颈动脉（BCA）移植物已被描述为一种可能优于膨体聚四氟乙烯血液通路移植物的选择。然而，已发表的经验仍然有限，非自体动静脉移植物的通畅率仍不尽人意。我们在此报告目前一代用于透析通路的BCA移植物的最大规模已发表经验，并分析亚组以确定肥胖、性别或既往通路手术是否会影响通畅率。
我们回顾性分析了2012年1月至2015年5月期间126例患者上肢植入的134例BCA移植物（Artegraft，新泽西州北不伦瑞克）用于血液透析通路的情况。患者平均有1.8次既往通路手术。使用Kaplan-Meier方法计算初次、初次辅助和二次通畅率，并列出纵向感染风险。使用对数秩检验方法计算通畅率差异。
对于整个队列，1年的初次通畅率为32%，初次辅助通畅率为49%，二次通畅率为78%。133例移植物中有10例（7%）在植入后1至9个月发生感染，需要切除移植物。男性和女性在初次或二次通畅率方面无统计学差异（P = 0.88，P = 0.69）。体重指数>30或<30的患者在初次通畅率或二次通畅率方面无差异（P = 0.85，P = 0.54）。首次尝试使用BCA移植物作为通路的患者，其初次和初次辅助通畅率高于既往通路失败后植入移植物的患者（P = 0.039，P = 0.024）。
这是现代时期已发表的关于BCA移植物用于动静脉移植物的最大系列研究。本系列中BCA移植物的初次通畅率低于一项规模较小的随机研究报告的结果。然而，初次辅助和二次通畅率相似。本系列中的感染率似乎略低于文献报道的聚四氟乙烯感染率。对于血液透析通路，BCA移植物是膨体聚四氟乙烯的一种令人满意的替代物，但需要更大规模的对照研究来确定先前报道的较高初次通畅率是否为可重复的发现。
