Morisson Bruno, de Araújo Antonio Luiz, Harduin Leonardo de Oliveira, Porcari Eglina Filgueiras, Fiorelli Rossano Kepler Alvim, Fiorelli Stenio Karlos Alvim, Serafim Jose Marcos Braz, de Oliveira Julio Cesar Peclat
Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Departamento de Pós graduação, Rio de Janeiro, RJ, Brasil.
Hospital Federal do Andarai - HFA, Departamento de Cirurgia Vascular, Rio de Janeiro, RJ, Brasil.
J Vasc Bras. 2018 Oct-Dec;17(4):303-309. doi: 10.1590/1677-5449.007117.
Many dialysis patients do not have the necessary conditions for construction of a native arteriovenous fistula (AVF). Expanded Polytetrafluoroethylene (ePTFE) vascular prostheses are the most widely-used option, but it is known that they are inferior to native vein AVFs.
To identify a graft with superior performance to ePTFE, comparing their results with those of AVFs made from bovine mesenteric arteries treated with L-Hydro technology (Labcor Laboratories ).
A prospective and controlled study of 10 patients with AVFs constructed with ePTFE and 10 patients with L-Hydro bioprostheses, matched for comorbidities. The variables studied were: primary patency, assisted primary patency, and secondary patency, surgical manipulability, and prevalence of infections. The performance of prostheses was assessed by duplex-scan and repeated consultations with health professionals at hemodialysis clinics. The chi-square test was used for statistical analysis.
After 1 year of postoperative follow-up, secondary and primary patency rates were higher for L-Hydro than ePTFE AVFs. Fewer interventions were needed to maintain AVF patency in the L-Hydro AVF group. The most common complication was graft thrombosis, which was more frequent in the ePTFE group. While the figures indicate more favorable outcomes in the L-Hydro AVFs, this could not be confirmed with the statistical treatment employed.
The L-Hydro graft appears to be a valuable alternative option for AVFs, since it seems to require fewer interventions to maintain patency when compared to ePTFE grafts.
许多透析患者不具备构建自体动静脉内瘘（AVF）的必要条件。膨体聚四氟乙烯（ePTFE）血管移植物是应用最广泛的选择，但已知其性能不如自体静脉动静脉内瘘。
识别一种性能优于ePTFE的移植物，并将其结果与采用L-Hydro技术（Labcor Laboratories公司）处理的牛肠系膜动脉制成的动静脉内瘘的结果进行比较。
对10例使用ePTFE构建动静脉内瘘的患者和10例使用L-Hydro生物假体的患者进行前瞻性对照研究，两组患者的合并症相匹配。研究的变量包括：初始通畅率、辅助初始通畅率、二期通畅率、手术可操作性以及感染发生率。通过双功超声扫描以及与血液透析诊所的医疗专业人员反复会诊来评估假体的性能。采用卡方检验进行统计分析。
术后随访1年后，L-Hydro动静脉内瘘的二期和初始通畅率高于ePTFE动静脉内瘘。L-Hydro动静脉内瘘组维持动静脉内瘘通畅所需的干预较少。最常见的并发症是移植物血栓形成，在ePTFE组中更为频繁。虽然数据表明L-Hydro动静脉内瘘的结果更有利，但采用的统计处理无法证实这一点。
L-Hydro移植物似乎是动静脉内瘘的一种有价值的替代选择，因为与ePTFE移植物相比，它似乎需要更少的干预来维持通畅。
