Article Highlights
- •This is Single-center, retrospective study
- •Primary, primary-assisted and secondary patency rates at 12 months in our study were higher than for PTFE.
- •Bovine carotid artery graft is a good conduit of choice for dialysis access
Abstract
Background
The hemodialysis dependent population is increasing in the United States. Dialysis
access complications are a significant source of morbidity and mortality for patients
with end stage renal disease (ESRD). A surgically created autogenous arteriovenous
fistula (AVF) has been the gold standard for dialysis access. However, for patients
who are not candidates for AVF, arteriovenous grafts using various conduits have widely
been utilized. In this study, we report the outcomes of bovine carotid artery (BCA)
grafts for dialysis access at a single institution, and compare these results to those
for polytetrafluoroethylene (PTFE) grafts.
Methods
A single-institution, retrospective review of all patients undergoing surgical placement
of a bovine carotid artery graft for dialysis access from 2017-2018 was performed
under an IRB-approved protocol. The primary, primary-assisted, and secondary patency
were calculated for the whole cohort and results determined based on gender, BMI and
indication for use. Comparison was performed to PTFE grafts at same institution from
2013 to 2016.
Results
One hundred and twenty two patients were included in this study. Seventy-four patients
had a BCA graft placed while 48 had a PTFE graft placed. . The mean age was 59.7±13.5
years in the BCA group, 55.8±14.5 in the PTFE group and the mean BMI was 29.8 ± 9.2
kg/m2 in the BCA group and 28.1±9.7 in the PTFE group. Comparison of the comorbidities
present in BCA/PTFE groups included hypertension (92%/100%), diabetes (57%/54%), congestive
heart failure (28%/10%), lupus (5%/7%), and chronic obstructive pulmonary disease
(4%/8%). The various configurations were reviewed (BCA/PTFE): interposition/access
salvage (40.5%/13%), axillary-axillary (18.9%/7%), brachial-basilic (5.4%,6%), brachial-brachial
(4.1%,4%), brachial-cephalic (1.4%0%), axillary-brachial (1.4%/0%), brachial-axillary
(23%, 62%), and femoral-femoral (5.4%,6%). Overall, twelve-month primary patency was
50% in the BCA group and 18% in the PTFE group (p=0.001). Twelve-month primary-assisted
patency was 66% in the BCA group and 37% in the PTFE group (p=0.003). Twelve-month
secondary patency was 81% in the BCA group and 36% in the PTFE group (p=0.07). When
comparing BCA graft survival probability among male and female gender, males had better
primary-assisted patency (p = 0.042). Secondary patency among the two genders was
similar. There was no statistically significant difference in primary, primary-assisted
and secondary patency of BCA grafts between different BMI groups or indication for
use. The average patency of a bovine graft was 17.8 ±8 months. Sixty-one percent of
the BCA grafts needed intervention with 24% needing multiple interventions. There
was an average of 7 ±5 months to first intervention. The infection rate was 8.1% in
the BCA group and 10.4% in the PTFE group with no statistical difference.
Conclusion
Primary and primary-assisted patency rates at 12 months in our study were higher than
those for PTFE at our institution. There was higher primary assisted patency of BCA
grafts among males at 12 months compared to PTFE. Obesity and indication for BCA graft
use did not appear to affect patency in our population.
Abbreviations:
BCA (Bovine Carotid Artery), ESRD (End Stage Renal Disease), IRB (Institutional Review Board), PTFE (Polytetrafluoroethylene), AVF (Arteriovenous Fistula), AVG (Arteriovenous Graft)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 3,
2023
Received in revised form:
February 1,
2023
Received:
August 18,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
