Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Ann Med. 2024 Dec;56(1):2424444. doi: 10.1080/07853890.2024.2424444. Epub 2024 Nov 8.
A series of cases have reported graft delamination as a rare complication of early-cannulation arteriovenous graft (ecAVG). The unique multilayer structure of ecAVGs contributes to the property of cannulation as early as hours after implantation, but on other hand it takes the risk of graft delamination. However, the underlying mechanism and management of graft delamination as well as its effects on the long-term patency of ecAVGs have not been systemically analyzed.
A retrospective study was conducted in a cohort of patients who required an ecAVG for hemodialysis (HD) access in our center between April 2017 and December 2021. The characteristics of graft delamination and the outcomes of its different treatments were analyzed.
A total of 144 ecAVGs were established in 141 end-stage renal disease (ESRD) patients, including 124 (86.1%) Acuseal grafts and 20 (13.9%) Flixene grafts. During follow-up 24.5(11.5, 45.8) months, 11 (7.6%) subjects had graft infection with an incidence of 0.03 patient-year. Thirteen (9.0%) subjects had graft delamination at 9.3(5.0,12.4) months after ecAVG implantation, with an incidence of 0.04 per patient-year. ecAVG delamination was observed in both Acuseal grafts (0.037 per patient-year) and Flixene grafts (0.055 per patient-year). Thrombosis or venous hypertension was the most common complaints. Seven delamination was observed at 1.3 (0.1, 4.2) months after an endovascular procedure. The primary patency, primary assistant patency and secondary patency in delamination group were significantly lower than that in non-delamination group ( < 0.05). Post-procedure primary patency of group A (percutaneous transluminal angioplasty, PTA), group B (stenting) and group C (partial graft replacement, PGR) were 1.3 (0.45,4.22) months, 5.3 (3.05,6.85) months and 8.45 (4.78,14.53) months respectively ( = 0.029).
Graft delamination was not a rare complication of ecAVGs in this cohort. It significantly reduced the long-term patency of AVGs. PGR might be a more effective therapeutic way than endovascular treatments.
已有一系列病例报告称，早期插管动静脉移植物（ecAVG）出现移植物分层是一种罕见的并发症。ecAVG 的独特多层结构有助于在植入后数小时内即可进行插管，但另一方面，它也增加了移植物分层的风险。然而，ecAVG 分层的潜在机制、处理方法及其对移植物长期通畅性的影响尚未得到系统分析。
本研究对 2017 年 4 月至 2021 年 12 月在我中心因血液透析（HD）通路需要建立 ecAVG 的患者队列进行了回顾性研究。分析了移植物分层的特征以及不同治疗方法的结果。
共有 141 例终末期肾病（ESRD）患者建立了 144 个 ecAVG，其中 Acuseal 移植物 124 个（86.1%），Flixene 移植物 20 个（13.9%）。在 24.5（11.5，45.8）个月的随访期间，11 例（7.6%）患者发生移植物感染，感染发生率为 0.03 例/患者年。ecAVG 植入后 9.3（5.0，12.4）个月时，13 例（9.0%）患者发生移植物分层，分层发生率为 0.04 例/患者年。Acuseal 移植物（0.037 例/患者年）和 Flixene 移植物（0.055 例/患者年）均观察到移植物分层。血栓形成或静脉高压是最常见的主诉。7 例分层发生在血管内操作后 1.3（0.1，4.2）个月。分层组的原发性通畅率、原发性辅助通畅率和继发性通畅率明显低于非分层组（<0.05）。A 组（经皮腔内血管成形术，PTA）、B 组（支架置入）和 C 组（部分移植物置换，PGR）的术后原发性通畅率分别为 1.3（0.45，4.22）个月、5.3（3.05，6.85）个月和 8.45（4.78，14.53）个月（=0.029）。
在本队列中，移植物分层不是 ecAVG 的罕见并发症。它显著降低了移植物的长期通畅率。PGR 可能是一种比血管内治疗更有效的治疗方法。
