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Heparin bonded PTFE does not improve hemodialysis arteriovenous graft function
Nicolas Zea, MD, Grayson Menard, MD, Linda Le, MD, Hernan A. Bazan, MD, W Charles Sternbergh, MD, Taylor Smith, MD.
Ochsner Clinic Foundation, New Orleans, LA, USA.
OBJECTIVES:
While heparin-bonded polytetrafluoroethylene (PTFE), when compared to standard PTFE, has been shown to be beneficial in distal extremity bypass grafts, the data supporting its usage for dialysis access is less clear. We compared the patency rates, number of interventions, and complications between heparin-bonded (HEP) and non-heparin-bonded (NonHEP) PTFE grafts placed for dialysis access.
METHODS:
A retrospective review of all dialysis access procedures entered into a prospectively maintained vascular surgery database was performed. Primary end points included functional graft patency, time to graft abandonment, and number of procedures required to re-establish graft patency following thrombosis. The number of interventions required to maintain graft patency and graft related complications were also reviewed. Kaplan-Meier curves were used to compare the two groups.
RESULTS:
Between January 2013 and March 2014, 301 dialysis access procedures were performed which included 72 AV grafts (AVG) comprised of 32 HEP (32 6mm straight grafts) and 39 NonHEP (36 4-7mm taper and 3 6mm straight). At a mean follow-up of 7.35 ± 5.15 months, 22/32 HEP grafts were functional compared to 31/39 NonHEP grafts (67% vs. 79%, p=0.22). Primary, primary-assisted, and secondary patency at 1, 3, 6 and 12 month follow-up was not significantly different between the HEP and NonHEP grafts. The incidence of grafts abandoned due to thrombosis (5 HEP, 4 NonHEP, 16% vs. 10%, p=0.51) and time to graft abandonment were also not different (4.55 ± 3.11 months vs. 2.38 ± 2.72, p=0.13). The number of HEP grafts undergoing an open or percutaneous thrombectomy was significantly higher than the NonHEP grafts (34% vs. 13%, p=0.03), as was the incidence of any intervention performed to maintain graft patency (84% vs. 51%, p= 0.002). Kaplan-Meier survival curve failed to show a benefit in functional patency with HEP vs. NonHEP PTFE
CONCLUSIONS:
We did not demonstrate a benefit to the routine use of heparin-bonded PTFE for AVG creation especially given the higher cost of these grafts. Functional patency rates were not improved and the rates of re-intervention were higher with heparin bonded PTFE AV grafts.
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