Comparison Of Bovine Artery And Polytetrafluoroethylene (PTFE) Grafts For Hemodialysis Access
Patrick Albert, MD, Muzammil Aziz, Zachary Connelly, Terry Lairmore, Chiranjiv Virk.
LSUHSC, SHREVEPORT, LA, USA.
OBJECTIVES: A surgically created autogenous arteriovenous fistula (AVF) has been the gold standard for dialysis access. However, for patients who are not candidates for AVF, arteriovenous grafts using various conduits have widely been utilized. 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. METHODS: 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 IRB-approved protocol. Comparison was performed to PTFE grafts at same institution from 2013 to 2016. RESULTS: 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 2 in the BCA group and 28.1±9.7 in the PTFE group. 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 femoralfemoral (5.4%,6%). Overall, twelve-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 two genders was similar. There was no statistically significant difference in primary, primary-assisted and secondary patency of BCA grafts between different BMI groups or indication for use. The average patency of a bovine graft was 17.8 ±8 months. The infection rate was 8.1% in the BCA group and 10.4% in the PTFE group with no statistical difference. CONCLUSIONS: 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.
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