Midterm results with the use of polycarbonate urethane heterografts for dialysis access

Abstract

Dialysis access surgery is currently one of the most common vascular operations as the dialysis patient population inceases. Although autogenous arteriovenous fistulae stand as the preferred method of access due to excellent patency and lower complication rates, grafts may provide alternative approaches when an autogenous fistula is impractical usually due to depleted veins. We aimed in this study to assess early and midterm outcome with the use of Expedial (TM) heterografts (LeMaitre Vascular Ltd., Wrexham, UK) for angioaccess between October 2000 and December 2004. Patients were prospectively followed for pre- and peri-operative course with 1st, 6th and 12th month outpatient controls for patency and complication rates. A total of 34 heterografts were implanted in 30 patients (22 males and 8 females; median age 60.6 years, range 32 - 70). The mean follow-up for 30 patients were 16.3 +/- 6.1 (range 4 - 30) months. 28 grafts (82.4%) were placed in forearm position. Primary and secondary patencies were found as 81% and 94%, respectively (p = 0. 15), with the median censored primary and secondary patencies of 27 1.7 months (95% CI, 23.38 to 30.67) and 30.42 +/- 1.1 months (95% CI, 28.30 to 32.54), respectively. Only presence of diabetes was found as a significant risk factor in the regression model (p = 0.01). We suggest that the polycarbonate urethane heterografts with acceptable patency/complication rates and shorter maturation times for dialysis access serve an alternative for these patients. (c) 2005 Tohoku University Medical Press.