Louisiana State University Health Sciences Center, Shreveport, LA.
Louisiana State University Health Sciences Center, Shreveport, LA.
Ann Vasc Surg. 2023 Aug;94:272-279. doi: 10.1016/j.avsg.2023.02.006. Epub 2023 Feb 20.
The hemodialysis-dependent population is increasing in the United States. Dialysis access complications are a significant source of morbidity and mortality for patients with end-stage renal disease. A surgically created autogenous arteriovenous fistula has been the gold standard for dialysis access. However, for patients who are not candidates for arteriovenous fistula, arteriovenous grafts using various conduits have widely been used. In this study, we report the outcomes of bovine carotid artery (BCA) grafts for dialysis access at a single institution and compare these results to those for polytetrafluoroethylene (PTFE) grafts.
A single-institution, retrospective review of all patients undergoing surgical placement of a bovine carotid artery graft for dialysis access from 2017-2018 was performed under an institutional review board-approved protocol. The primary, primary-assisted, and secondary patency were calculated for the whole cohort and results determined based on gender, body mass index (BMI), and indication for use. Comparison was performed to PTFE grafts at same institution from 2013 to 2016.
One hundred and twenty two patients were included in this study. Seventy four patients had a BCA graft placed while 48 had a PTFE graft placed. . The mean age was 59.7 ± 13.5 years in the BCA group, 55.8 ± 14.5 in the PTFE group, and the mean BMI was 29.8 ± 9.2 kg/m in the BCA group and 28.1 ± 9.7 in the PTFE group. Comparison of the comorbidities present in BCA/PTFE groups included hypertension (92%/100%), diabetes (57%/54%), congestive heart failure (28%/10%), lupus (5%/7%), and chronic obstructive pulmonary disease (4%/8%). The various configurations were reviewed (BCA/PTFE): interposition/access salvage (40.5%/13%), axillary-axillary (18.9%, 7%), brachial-basilic (5.4%, 6%), brachial-brachial (4.1%, 4%), brachial-cephalic (1.4%, 0%), axillary-brachial (1.4%, 0%), brachial-axillary (23%, 62%), and femoral-femoral (5.4%, 6%). Overall, 12-month primary patency was 50% in the BCA group and 18% in the PTFE group (P = 0.001). Twelve-month primary-assisted patency was 66% in the BCA group and 37% in the PTFE group (P = 0.003). Twelve-month secondary patency was 81% in the BCA group and 36% in the PTFE group (P = 0.07). When comparing BCA graft survival probability among male and female gender, males had better primary-assisted patency (P = 0.042). Secondary patency among the 2 genders was similar. There was no statistically significant difference in primary, primary-assisted, and secondary patency of BCA grafts between different BMI groups and indication for use. The average patency of a bovine graft was 17.8 ± 8 months. Sixty one percent of the BCA grafts needed intervention with 24% needing multiple interventions. There was an average of 7 ± 5 months to first intervention. The infection rate was 8.1% in the BCA group and 10.4% in the PTFE group with no statistical difference.
Primary and primary-assisted patency rates at 12 months in our study were higher than those for PTFE at our institution. There was higher primary-assisted patency of BCA grafts among males at 12 months compared to PTFE. Obesity and indication for BCA graft use did not appear to affect patency in our population.
美国依赖血液透析的患者人数不断增加。透析通路并发症是终末期肾病患者发病率和死亡率的重要原因。自体动静脉瘘已成为透析通路的金标准。然而，对于不适合动静脉瘘的患者，使用各种导管的动静脉移植物已广泛应用。在这项研究中，我们报告了在一家机构中单用牛颈动脉（BCA）移植物进行透析通路的结果，并将这些结果与聚四氟乙烯（PTFE）移植物进行了比较。
对 2017 年至 2018 年期间，根据机构审查委员会批准的方案，对在一家机构中使用牛颈动脉移植物进行透析通路的所有患者进行了单机构回顾性研究。对整个队列的主要、主要辅助和次要通畅率进行了计算，并根据性别、体重指数（BMI）和使用指征进行了结果确定。与同期同一机构的 PTFE 移植物进行了比较。
本研究共纳入 122 例患者。74 例患者植入了 BCA 移植物，48 例患者植入了 PTFE 移植物。BCA 组的平均年龄为 59.7±13.5 岁，PTFE 组为 55.8±14.5 岁，BCA 组的平均 BMI 为 29.8±9.2kg/m，PTFE 组为 28.1±9.7kg/m。比较 BCA/PTFE 组的并存疾病，包括高血压（92%/100%）、糖尿病（57%/54%）、充血性心力衰竭（28%/10%）、狼疮（5%/7%）和慢性阻塞性肺疾病（4%/8%）。对各种配置（BCA/PTFE）进行了回顾：间置/通路修复（40.5%/13%）、腋-腋（18.9%，7%）、肱-桡（5.4%，6%）、肱-肱（4.1%，4%）、肱-头（1.4%，0%）、腋-肱（1.4%，0%）、肱-腋（23%，62%）和股-股（5.4%，6%）。总的来说，BCA 组 12 个月的主要通畅率为 50%，PTFE 组为 18%（P=0.001）。BCA 组 12 个月的主要辅助通畅率为 66%，PTFE 组为 37%（P=0.003）。BCA 组 12 个月的次要通畅率为 81%，PTFE 组为 36%（P=0.07）。当比较男性和女性 BCA 移植物的生存率时，男性的主要辅助通畅率更好（P=0.042）。两种性别之间的次要通畅率相似。不同 BMI 组和使用指征之间，BCA 移植物的主要、主要辅助和次要通畅率没有统计学差异。牛移植物的平均通畅时间为 17.8±8 个月。61%的 BCA 移植物需要干预，其中 24%需要多次干预。第一次干预的平均时间为 7±5 个月。BCA 组的感染率为 8.1%，PTFE 组为 10.4%，无统计学差异。
本研究中，我们的 12 个月主要和主要辅助通畅率高于同期本机构的 PTFE。与 PTFE 相比，男性 12 个月时 BCA 移植物的主要辅助通畅率更高。肥胖和 BCA 移植物使用指征似乎没有影响我们人群的通畅率。
