Abdoli Sherwin, Mahajan Anuj, Han Sukgu M, Rowe Vincent L, Katz Steven G, Ochoa Christian J
Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, Calif; Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif.
Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, Calif; Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif.
J Vasc Surg. 2018 Dec;68(6):1865-1871. doi: 10.1016/j.jvs.2018.04.061. Epub 2018 Jun 28.
Tunneled dialysis catheter (TDC) use has been associated with increased infectious complications and mortality in hemodialysis-dependent patients. Unfortunately, patients who undergo fistula revisions or creation of a new arteriovenous fistula frequently require a TDC during the postoperative period. Bovine carotid artery grafts (BCAGs) can be used as an early-access dialysis conduit to reduce TDC dependence. This study describes the performance of BCAGs that were cannulated early (<3 days) after implantation and associated clinical outcomes.
BCAGs were implanted in 63 consecutive dialysis-dependent patients. Patients and dialysis centers were directly provided early cannulation instructions; 31 (49%) patients were cannulated early, and of the 31 patients cannulated early, 21 (68%) were cannulated during the first postoperative day. Early complications, primary patency, secondary patency, and TDC incidence were monitored through clinic visits, hospital records, and phone calls to dialysis centers.
The primary patency of BCAGs at 1 year in the early and late cannulation cohorts was 28% and 39%, respectively. The secondary patency of BCAGs at 1 year in the early and late cannulation cohorts was 74% and 77%, respectively. Early complications occurred in 11 (19%) patients who received a BCAG. There were no significant differences in complication rates between early and late cannulation patients. Of the 24 patients who underwent the operation without a pre-existing TDC, only three (13%) required TDC placement during the 30-day postoperative period.
BCAGs can be cannulated early without increased complication rates or a negative impact on midterm patency. Early cannulation of BCAGs obviates the need for a TDC postoperatively in dialysis-dependent patients undergoing primary vascular access or fistula revision procedures.
在依赖血液透析的患者中，使用隧道式透析导管（TDC）与感染并发症增加及死亡率升高相关。不幸的是，接受动静脉内瘘修复或新建动静脉内瘘的患者在术后期间常常需要使用TDC。牛颈动脉移植物（BCAG）可作为早期透析通路导管以减少对TDC的依赖。本研究描述了植入后早期（<3天）进行插管的BCAG的性能及相关临床结局。
连续63例依赖透析的患者植入BCAG。直接向患者及透析中心提供早期插管指导；31例（49%）患者进行了早期插管，在31例早期插管的患者中，21例（68%）在术后第一天进行了插管。通过门诊就诊、医院记录以及与透析中心电话联系来监测早期并发症、初次通畅率、二次通畅率及TDC发生率。
早期和晚期插管队列中BCAG在1年时的初次通畅率分别为28%和39%。早期和晚期插管队列中BCAG在1年时的二次通畅率分别为74%和77%。11例（19%）接受BCAG的患者发生了早期并发症。早期和晚期插管患者的并发症发生率无显著差异。在24例术前未使用TDC的手术患者中，仅3例（13%）在术后30天内需要放置TDC。
BCAG可早期插管，且不增加并发症发生率或对中期通畅率产生负面影响。对于接受初次血管通路或内瘘修复手术的依赖透析患者，早期对BCAG进行插管可避免术后使用TDC。
