Editor's Choice - Outcomes of Cold Stored Saphenous Vein Allografts for Haemodialysis Vascular Access.

Autor: Cherkaoui R; Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Vandoeuvre-Les-Nancy, France., Picard E; Department of Vascular and Thoracic Surgery, Nimes University Hospital, Nimes, France., Branchereau P; Department of Vascular and Thoracic Surgery, Nimes University Hospital, Nimes, France., Saba C; Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Vandoeuvre-Les-Nancy, France., Derycke L; Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, Paris, France., Settembre N; Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Vandoeuvre-Les-Nancy, France; University of Lorraine, INSERM UMR_S 1116 DCAC, Nancy, France., Malikov S; Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Vandoeuvre-Les-Nancy, France; University of Lorraine, INSERM UMR_S 1116 DCAC, Nancy, France., Faure EM; Department of Vascular and Thoracic Surgery, Nimes University Hospital, Nimes, France; University of Nimes, UR-UM 103 IMAGINE, Nimes, France. Electronic address: elsa.faure@chu-nimes.fr.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Sep; Vol. 68 (3), pp. 397-404. Date of Electronic Publication: 2024 May 07.
DOI: 10.1016/j.ejvs.2024.04.042
Abstrakt: Objective: The aim of this study was to evaluate the outcomes of cold stored saphenous vein allografts (CSVAs) for haemodialysis vascular access.
Methods: A retrospective, two centre study was conducted between January 2016 and December 2020 of all patients who had CSVA placement for haemodialysis vascular access. Primary, primary assisted, and secondary patency were analysed, as well as procedural complications and re-interventions.
Results: One hundred and nine patients (n = 55 women) with a mean age of 67.2 ± 13.6 years, with no options for creating an autogenous arteriovenous fistula, were included in the study. At one year, primary, primary assisted, and secondary patency were 37.6%, 59.0%, and 73.3%, respectively; and at two years 19.9%, 42.5%, and 54.9%, respectively. During a mean follow up period of 26 ± 18 months, five patients (4.6%) had an access infection, with no related death. During the follow up period, 32 patients (29.4%) died and 13 patients (11.9%) underwent a kidney transplant. None of these patients showed immunoconversion before transplantation. The cumulative incidence of adverse events by the Fine-Gray method was calculated. Considering competing risks (death and renal transplantation), 9.2% of patients lost their vascular access at one year and 18% at two years. Moreover, 57.8% patients had stenosis, mainly on the outflow (45.9%), and 49.5% had thrombosis.
Conclusion: With a comparable patency rate associated with a low infection rate, CSVA offers a potential alternative to expanded polytetrafluoroethylene grafts. This creates haemodialysis vascular access when the venous capital is exhausted in patients with reported risk factors for vascular access infection, i.e., insertion in the thigh, advanced age, diabetes mellitus, immunocompromised state, obesity, or revision of an infected prosthetic graft.
(Copyright © 2024 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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