Department of Vascular surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
Department of Nephrology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
J Vasc Access. 2023 Sep;24(5):972-979. doi: 10.1177/11297298211013133. Epub 2021 Nov 30.
To evaluate the long-term patency rate of the arteriovenous angioaccess (AVA) with interposition of either autologous or prosthetic material as a last option for vascular access in the upper extremity.
This is a retrospective chart review study of all patients who received an AVA with autologous saphenous vein (SV Group, = 38) or prosthetic material (PTFE Group, = 25) as a conduit from the year 1996 to 2020 in the Radboud University Medical Center (Radboudumc). Data were retrospectively extracted from two prospectively updated local databases for vascular access, one for haemodialysis (HD) and one for parenteral nutrition (PN). When required, the medical records of each patient were used. Data were eventually collected anonymously and analysed in SPSS 25. Kaplan-Meier life-tables were used for the statistical analysis.
Primary patency at 12 and 48 months was 30% and 20% in the SV group and 45% and 14% in the PTFE group. No significant difference was shown in the median primary patency rate ( = 0.715). Secondary patency at 12 and 48 months was 63% and 39% in the SV group and 55% and 19% in the PTFE group. This was considered a significant difference in median secondary patency in favour of the SV with 41.16 ± 17.67 months against 13.77 ± 10.22 months for PTFE ( = 0.032). The incidence of infection was significantly lower in the SV group ( = 0.0002). A Kaplan-Meier curve could not detect a significant difference in secondary patency between the access for haemodialysis and the access for parenteral nutrition. The secondary patency of the SV in parenteral nutrition access, was significantly higher when compared with PTFE ( = 0.004).
The SV can be preferred over PTFE when conduit material is needed for long-term vascular access for HD or PN treatment due to its higher secondary patency and lower infection risk.
评估自体或人工材料作为上肢血管通路的最后选择的动静脉血管造口术（AVA）的长期通畅率。
这是一项回顾性图表研究，纳入了 1996 年至 2020 年期间在 Radboud 大学医学中心（Radboudumc）接受自体大隐静脉（SV 组，n=38）或人工材料（PTFE 组，n=25）作为导管的所有 AVA 患者。数据从两个前瞻性更新的血管通路局部数据库中提取，一个用于血液透析（HD），一个用于肠外营养（PN）。必要时，使用每位患者的病历。最终匿名收集数据并在 SPSS 25 中进行分析。Kaplan-Meier 生存表用于统计分析。
SV 组的 12 个月和 48 个月的原发性通畅率分别为 30%和 20%，PTFE 组分别为 45%和 14%。中位原发性通畅率无显著差异（ = 0.715）。SV 组的 12 个月和 48 个月的继发性通畅率分别为 63%和 39%，PTFE 组分别为 55%和 19%。SV 的中位继发性通畅率明显更高，优势比为 41.16±17.67 个月，PTFE 为 13.77±10.22 个月，差异有统计学意义（ = 0.032）。SV 组的感染发生率明显较低（ = 0.0002）。Kaplan-Meier 曲线无法检测到 HD 和 PN 治疗的血管通路之间继发性通畅率的显著差异。与 PTFE 相比，SV 在 PN 通路中的继发性通畅率更高（ = 0.004）。
由于 SV 的继发性通畅率更高，感染风险更低，因此在需要长期血管通路进行 HD 或 PN 治疗时，自体材料优于 PTFE。
