Coyne D W, Lowell J A, Windus D W, Delmez J A, Shenoy S, Audrain J, Howard T K
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110-1093, USA.
J Am Coll Surg. 1996 Oct;183(4):401-5.
Placement and maintenance of a well-functioning vascular access are essential for delivery of adequate hemodialysis. Newly placed polytetrafluoroethylene (PTFE) arteriovenous grafts require a period of wound healing and incorporation of fibrous tissue before use, a period typically lasting two to three weeks. An ideal PTFE graft would be one that can be used for vascular access immediately, obviating the need for temporary dialysis catheters. Recently an expanded PTFE (ePTFE) graft with a mesh cannulation segment (Diastat graft) has been proposed for early cannulation.
This is a retrospective single-center study comparing ePTFE graft survival to contemporaneously placed standard wall PTFE (GORE-TEX) grafts.
Forty-seven consecutive new or established patients receiving chronic hemodialysis had grafts (25 ePTFE, 22 standard PTFE) placed between November 1994 and July 1995. There were no significant differences between the groups in age, race, gender, incidence of diabetes mellitus, or peripheral vascular disease. By the end of the study, 21 of 25 ePTFE grafts had clotted, compared with 11 of the 22 patients receiving a standard PTFE graft. Median time to first clotting was 53 days for the ePTFE grafts and 164 days for the standard PTFE grafts (p < 0.0001). Nine patients with ePTFE grafts required a temporary catheter after their first clotting episode.
The ePTFE grafts thrombosed at a significantly higher rate than standard wall PTFE grafts. Further experience with the Diastat graft might improve graft survival. However, early experience does not suggest that the avoidance of short-term temporary access outweighs the problem of high clotting rate, and its attendant morbidity.
建立并维持功能良好的血管通路对于充分进行血液透析至关重要。新植入的聚四氟乙烯（PTFE）动静脉移植物在使用前需要一段时间进行伤口愈合和纤维组织融合，这段时间通常持续两到三周。理想的PTFE移植物应能立即用于血管通路，从而无需使用临时透析导管。最近，一种带有网状插管段的膨体聚四氟乙烯（ePTFE）移植物（Diastat移植物）被提出用于早期插管。
这是一项回顾性单中心研究，比较ePTFE移植物与同期植入的标准壁PTFE（GORE-TEX）移植物的存活情况。
1994年11月至1995年7月期间，47例接受慢性血液透析的新患者或已确诊患者接受了移植物植入（25例ePTFE，22例标准PTFE）。两组在年龄、种族、性别、糖尿病发病率或外周血管疾病方面无显著差异。到研究结束时，25例ePTFE移植物中有21例发生凝血，而接受标准PTFE移植物的22例患者中有11例发生凝血。ePTFE移植物首次凝血的中位时间为53天，标准PTFE移植物为164天（p<0.0001）。9例使用ePTFE移植物的患者在首次凝血事件后需要使用临时导管。
ePTFE移植物的血栓形成率明显高于标准壁PTFE移植物。Diastat移植物的进一步应用经验可能会提高移植物的存活率。然而，早期经验并不表明避免短期临时通路的益处超过高凝血率及其相关并发症的问题。
