Cryopreserved venous allograft is an acceptable conduit in patients with current or prior angioaccess graft infection
| Autor: | Michael P. Harlander-Locke, Christopher J. Abularrage, James Kohn, Peter F. Lawrence, Esther Bae, Michael Ricci, Gary W. Lemmon, Sotero Peralta, Jeffrey H. Hsu, Aamna Ali |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Groin business.industry medicine.medical_treatment Fistula Femoral vein 030204 cardiovascular system & hematology medicine.disease Thrombosis Surgery 03 medical and health sciences surgical procedures operative 0302 clinical medicine medicine.anatomical_structure medicine Vascular Patency 030212 general & internal medicine Hemodialysis Cardiology and Cardiovascular Medicine business Vein Dialysis |
| Zdroj: | Journal of Vascular Surgery. 66:1157-1162 |
| ISSN: | 0741-5214 |
| Popis: | Objective The durability of cryopreserved allograft has been previously demonstrated in the setting of infection. The objective of this study was to examine the safety, efficacy, patency, and cost per day of graft patency associated with using cryopreserved allograft (vein and artery) for hemodialysis access in patients with no autogenous tissue for native fistula creation and with arteriovenous graft infection or in patients at high risk for infection. Methods Patients implanted with cryopreserved allograft for hemodialysis access between January 2004 and January 2014 were reviewed using a standardized, multi-institutional database that evaluated demographic, comorbidity, procedural, and outcomes data. Results There were 457 patients who underwent placement of cryopreserved vein (femoral: n = 337, saphenous: n = 11) or artery (femoral: n = 109) for hemodialysis access at 20 hospitals. Primary indications for allograft use included high risk of infection in 191 patients (42%), history of infected prosthetic graft in 169 (37%), and current infection in 97 (21%). Grafts were placed more frequently in the arm (78%) than in the groin, with no difference in allograft conduit used. Mean time from placement to first hemodialysis use was 46 days (median, 34 days). Duration of functional graft use was 40 ± 7 months for cryopreserved vein and 21 ± 8 months for cryopreserved artery ( P P P = .030, P = .017, respectively), and late thrombosis occurred more frequently with cryopreserved artery ( P P = .312) compared with the remainder of the study population. The 1-, 3-, and 5-year primary patency was 58%, 35%, and 17% for cryopreserved femoral vein and 49%, 17%, and 8% for artery, respectively ( P P P Conclusions Cryopreserved allograft provides an excellent conduit for angioaccess when autogenous tissue is not available in patients with current or past conduit infection. Cryopreserved vein was associated with higher patency and a lower cost per day of graft patency. Cryopreserved allograft allows for immediate reconstruction through areas of infection, reduces the need for staged procedures, and allows early use for dialysis. |
| Databáze: | OpenAIRE |
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