Objectives To compare the clinical application of Acuseal artificial blood vessel and expanded polytetrafluoroethylene artificial vessel (ePTFE) as the arteriovenous graft (AVG) for hemodialysis access so as to provide reference for clinical use. Methods A retrospective study was performed on 61 patients undergoing AVG surgery in the Department of Nephrology, Jinan Central Hospital from December 2019 to December 2020. They were divided into observation group (Acuseal group) and control group (ePTFE group) according to the type of artificial blood vessel used. The first puncture time of internal fistula, the use of central venous catheter (CVC), patency rate and complications after the operation for one year were compared between the two groups. Results The surgery time was different between observation group and control group (U=279.000, P=0.024). The first puncture time were 4 (3, 6) days and 31 (30, 39) days after the surgery in observation group and control group respectively. CVC indwelling period was different (U=167.000, P<0.001), but the rate of CVC used was similar (χ2=0.000, P=1.000) between the two groups. The primary patency rate after 6 months was 54.5% in observation group and was 66.7% in control group (χ2=0.934, P=0.334), and the rate after 12 months was 22.7% in observation group and was 38.5% in control group (χ2=1.984, P=0.159), without statistical significances between the two groups. The cumulative patency rate after 6 months was 90.9% in observation group and was 100% in control group (χ2=3.629, P=0.057), and the rate after 12 months was 81.8% in observation group and was 94.9% in control group (χ2=2.758, P=0.097), also without statistical significances between the two groups. Postoperative complications were similar between the two groups. The artificial vessel in observation group was completely removed if it was infected. Conclusion Acuseal artificial blood vessel allows early puncture and has similar patency rate. However, due to the difficulties in surgery, the removal of the whole dialysis pathway after infection leading to the use of CVC, the AVG using Acuseal artificial blood vessel should be carefully weighed in clinical practice.
YANG Ke
,
HE Lan-Lan
,
WANG Xiao-Ping
. Comparison of the clinical application of Acuseal artificial vessel and expanded polytetrafluoroethylene artificial vessel [J]. Chinese Journal of Blood Purification, 2022
, 21(10)
: 770
-774
.
DOI: 10.3969/j.issn.1671-4091.2022.10.015
[1] Anamika Adwaney, Charlotte Lim, Sarah Blakey, et al. Central venous stenosis, access outcome and survival in patients undergoing maintenance hemodialysis[J]. Clin J Am Soc Nephrol,2019,14(3):378-384.
[2] Pisoni RL, Zepel L, Port FK, et al. Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons[J]. Am J Kidney Dis,2015,65(6):905-915.
[3] 王梦迪, 张凌, 刘鹏,等.终末期肾脏病患者初次血液透析血管 通路应用的多中心调查[J]. 中华肾脏病杂志,2016,32(6):418-424.
[4] Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses[J]. J Vasc Surg,2002,35(3):603-610.
[5] Glickman MH, Burgess J, Cull D, et al. Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis[J]. J Vasc Surg, 2015, 62(2):434–441.
[6] Aitken EL, Jackson AJ, Kingsmore DB. Early cannulation prosthetic graft (Acuseal) for arteriovenous access: a useful option to provide a personal vascular access solution[J]. J Vasc Access, 2014, 15(6): 481-485.
[7] Tozzi M, Franchin M, Ietto G, et al. Initial experience with the Gore Acuseal graft for prosthetic vascular access[J]. J Vasc Access, 2014, 15(5): 385-390.
[8] Wagner JK, Dillavou E, Nag U, et al. Immediate-access grafts provide comparable patency tostandard grafts, with fewer reinterventions and catheter-related complications[J]. J Vasc Surg, 2019, 69(3): 883–889.
[9] He J, Zeng Q, Lang F, et al. Early cannulation arteriovenous graft (Acuseal) versus standard arteriovenous graft in patients with end-stage renal disease. Hemodial Int, 2021, 25(4): 465-472.
[10] 廖冬梅,汪元玉,钟玲,等. 新型即穿式人工血管在透析通路中的临床应用研究[J].中国血液净化,2020,19(4):278-281.
[11] Silva MB Jr, Hobson RW, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation[J]. J Vasc Surg, 1998, 27(2): 302-307.
[12] Glickman MH, Burgess J, Cull D, et al. Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis[J]. J Vasc Surg, 2015, 62(2): 434–441.
[13] Shemesh D, Goldin I, Hijazi J, et al. A prospective randomized study of heparin-bonded graft (Propaten) versus standard graft in prosthetic arteriovenous access[J]. J Vasc Surg, 2015, 62(1): 115-122.
[14] Inston N, Mistry H, Gilbert J, et al. Aneurysms in vascular access: state of the art and future developments[J]. J Vasc Access, 2017, 18(6):464-472.
[15] MacKenzie DJ, Isaak A, Nash J, Meldrum AD, et al. Early Cannulation ePTFE Arteriovenous Access Grafts are Associated with a Low Incidence of Pseudoaneurysm Formation[J]. Ann Vasc Surg, 2020, 64: 270-275.
[16] Franco RP. Is the Fistula First Approach still valid[J]?J Bras Nefrol. 2021,43(2):263-268.
[17] Dai R, Broadwell SR, Lessne ML, et al. Arteriovenous Graft Delamination and Dissection as a Cause of Graft Dysfunction[J]. J Vasc Interv Radiol, 2020, 31(5): 852-854e1.
[18] Suemitsu K, Shiraki T, Miyamoto M, et al. Delamination of Acuseal early cannulation arteriovenous graft months after implantation[J]. J Vasc Access, 2021, 22(5): 840-844.
[19] Thakur S, Pigott JP, Comerota AJ. Heparin-induced thrombocytopenia after implantation of a heparin-bonded polytetrafluoroethylene lower extremity bypass graft: A case report and plan for management[J]. J Vasc Surg, 2009, 49(4): 1037-1040.
[20] Wheatcroft MD, Greco E, Tse L, et al. Heparin-induced thrombocytopenia in the presence of a heparin-bonded bypass graft[J]. Vascular, 2011, 19(6): 338-341.
[21] Kasirajan K. Outcomes after heparin-induced thrombocytopenia in patients with Propaten vascular grafts [J]. Ann Vasc Surg, 2012, 26(6): 802-808.