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Bovine Carotid Artery Biological Graft Out Performs ePTFE for Hemodialysis Access
Thomas Reifsnyder, MD, Isibor J. Arhuidese, MD MPH, Tasnim Islam, BA, Joshua Grimm, MD, Umair Qazi, MD MPH, Tammam Obeid, MD, Mahmoud B. Malas, MD MHS.
Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Objectives: Autogenous arteriovenous fistula remains the gold standard for hemodialysis access. Non-autogenous conduit provides an alternative access in the setting of inadequate veins. In this study, long-term functional patency between two non-autogenous conduits, bovine biograft and polytetrafluoroethylene (ePTFE) is compared. 
Methods: This single institution retrospective review of 120 consecutive grafts placed in 98 patients between January 2011 and June 2014. Univariate methods (Chi Square, ANOVA ) were employed to compare demographic and medical characteristics of patients that received each graft type.  Kaplan-Meier and Cox regression analyses were used to evaluate time to loss of patency and identify its predictors. Log rank tests were carried out to compute differences in functional survival of the grafts between both groups. Outcomes were defined and analyzed per standards published by the Society for Vascular Surgery. Follow-up commenced at the time the graft was first used for “functional” outcomes or at graft placement and ended with the occurrence of an event, death or study closure.
Results: There was no difference in the functional primary and assisted primary patency comparing ePTFE to biograft (Table 1). Functional secondary patency at 6months, 1 year and 18 months for biograft and PTFE are 76%, 72%, 72% and 52%, 46%, 46% respectively. There was a six fold increase in the hazard of loss of functional secondary patency in ePTFE compared to biograft (HR: 6.8 95%CI: 1.7-26.3, P=0.006). Graft infection rates were higher for ePTFE compared to biografts (21% Vs 15%). The significant predictors of patency loss were high-BMI and hyperlipidemia.
Conclusions:  In this cohort, primary and primary assisted patency are similar between biografts and ePTFE conduits. However, bovine biografts confer a significant advantage compared to ePTFE with regards to functional secondary patency. 
Hazards of loss of outcome
OutcomeBovine biograftPTFE95% CIP-value
Primary patency10.960.56-1.630.88
Functional primary patency10.880.39-1.990.76
Primary assisted patency11.150.66-2.020.62
Functional primary assisted patency11.110.48-2.590.80
Secondary patency12.561.27-5.190.009
Functional secondary patency16.761.73-26.340.006

Table1. Hazards of graft failure comparing PTFE to bovine biograft

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