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Objective:
The optimal hemodialytic vascular access still remains the native arteriovenous fistula. If anatomically feasible, it is preferred to the early use of prosthetic material. Native vessels consumption in long-lasting hemodialysis and aging of the population accessing hemodialytic treatment, increase the use of prosthetic grafts. We analyzed our prosthetic accesses series.
Methods:
Data concerning hemodialytic prosthetic accesses created in our institution from 1998/1 to 2011/8 were reviewed. Patency rates were calculated with Kaplan-Meier method.
Results:
On 800 arteriovenous fistulas, 104 (13%) are prosthetic. Follow-up (1998/2-2012/2) is available for 94 (90,3%). Twelve (12.7%) prosthetic grafts were placed as first vascular access. Five (5.3%) early failure were observed. Eighty-nine accesses created in 72 patients (38M; 34F; 70,5 years-old-median age at surgery) allowed hemodialytic treatment, resulting eligible to thorough follow-up: 22 biologic (depopulated bovine ureter - SynerGraft®), 67 PTFE. All grafts were placed in the upper extremities: 46 forearm, 43 arm, (61 left, 28 right).
Cumulative primary patency rates at 12, 36 and 60 months were: 41%, 16% and 3%, respectively; for biologic 60.5%, 16% and not significant (n.s.), respectively; for PTFE 34%, 14% and 4%, respectively.
Cumulative assisted primary patency rates at 12, 36 and 60 months were: 46%, 27% and 12.4%, respectively; for biologic 69.9%, 38.8% and 19.9%, respectively; for PTFE 37%, 23% and 11.4%, respectively.
Cumulative secondary patency rates at 12, 36 and 60 months were: 80%, 61% and 45%, respectively; for biologic 89%, 74% and 44.8%, respectively; for PTFE 76%, 56% and 46%, respectively.
Complications observed were: infection, in 4,5% biologic (1/22) and in 6% PTFE (4/67); aneurysm or false aneurysm, both requiring surgical correction, in 18% biologic (4/22) and in 6% PTFE (4/67); 47 stenosis, in 41% biologic (9/22) and in 28.6% (12/67); 88 thrombosis, in 41% biologic (9/22) and in 52% PTFE (35/67).
Conclusions:
We used both PTFE and SynerGraft®, the latter until available (2008). Since then we have been using PTFE only. Despite its tendency to dilation, we assumed good results with SynerGraft®. However, in our experience, latest PTFE grafts represent a valid and reliable option when native vessels are depleted. An increase in the use of prosthetic grafts is expected. Long-time employment and deterioration of graft material constitute a matter of challenge. Further improvements for long-term performance are desirable.