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. 2018 Oct-Dec;17(4):303-309.
doi: 10.1590/1677-5449.007117.

A pilot study comparing bovine mesenteric artery and expanded polytetrafluoroethylene grafts as non-autogenous hemodialysis options

Bruno Morisson  1   2   3 , Antonio Luiz de Araújo  1 , Leonardo de Oliveira Harduin  3   4 , Eglina Filgueiras Porcari  2 , Rossano Kepler Alvim Fiorelli  1 , Stenio Karlos Alvim Fiorelli  1 , Jose Marcos Braz Serafim  1 , Julio Cesar Peclat de Oliveira  3   4
Affiliations

A pilot study comparing bovine mesenteric artery and expanded polytetrafluoroethylene grafts as non-autogenous hemodialysis options

Bruno Morisson et al. J Vasc Bras. 2018 Oct-Dec.

Abstract
in English, Portuguese

Background: Many dialysis patients do not have the necessary conditions for construction of a native arteriovenous fistula (AVF). Expanded Polytetrafluoroethylene (ePTFE) vascular prostheses are the most widely-used option, but it is known that they are inferior to native vein AVFs.

Objectives: To identify a graft with superior performance to ePTFE, comparing their results with those of AVFs made from bovine mesenteric arteries treated with L-Hydro technology (Labcor Laboratories ®).

Methods: A prospective and controlled study of 10 patients with AVFs constructed with ePTFE and 10 patients with L-Hydro bioprostheses, matched for comorbidities. The variables studied were: primary patency, assisted primary patency, and secondary patency, surgical manipulability, and prevalence of infections. The performance of prostheses was assessed by duplex-scan and repeated consultations with health professionals at hemodialysis clinics. The chi-square test was used for statistical analysis.

Results: After 1 year of postoperative follow-up, secondary and primary patency rates were higher for L-Hydro than ePTFE AVFs. Fewer interventions were needed to maintain AVF patency in the L-Hydro AVF group. The most common complication was graft thrombosis, which was more frequent in the ePTFE group. While the figures indicate more favorable outcomes in the L-Hydro AVFs, this could not be confirmed with the statistical treatment employed.

Conclusions: The L-Hydro graft appears to be a valuable alternative option for AVFs, since it seems to require fewer interventions to maintain patency when compared to ePTFE grafts.

Contexto: Muitos pacientes dialíticos apresentam condições desfavoráveis para confecção de fístula arteriovenosa (FAV) nativa. A prótese vascular de politetrafluoroetileno expandido (ePTFE) é a alternativa mais utilizada, porém, sabidamente inferior àquela com veias nativas.

Objetivos: Pesquisar um enxerto de performance superior à do ePTFE, confrontrando seus resultados com os de FAVs confeccionadas com artéria mesentérica bovina tratada com tecnologia L-Hydro (Labcor Laboratórios®).

Métodos: Estudo prospectivo e controlado, composto pelo grupo controle de 10 pacientes submetidos à confecção de FAV com ePTFE (FAV ePTFE) e grupo experimental de 10 pacientes com bioprótese L-Hydro (FAV L-Hydro). Os componentes foram pareados em relação às comorbidades apresentadas. As variáveis estudadas foram: perviedades primária, primária assistida e secundária, manuseabilidade e prevalência de infecções. A performance das próteses foi avaliada por duplex scan e por consultas seriadas realizadas por profissionais de clínicas de hemodiálise. O tratamento estatístico foi o teste do qui-quadrado.

Resultados: Após 1 ano de seguimento pós-operatório, as taxas de perviedade secundária e primária assistida foram maiores no grupo FAV L-Hydro do que no FAV ePTFE. As intervenções para manter a perviedade da FAV foram menores no grupo FAV L-Hydro. A complicação mais comum foi trombose do enxerto, mais frequente no grupo FAV ePTFE. Apesar de os números indicarem desfechos mais favoráveis nas FAV L-Hydro, não foi possível confirmar esse achado com o tratamento estatístico aplicado.

Conclusões: O enxerto L-Hydro parece ser uma alternativa valiosa para FAV, pois parece necessitar de menos intervenções para manutenção da perviedade, quando comparado ao enxerto de ePTFE.

Keywords: fistula; hemodialysis; patency.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Prosthesis before implantation.
Figure 2
Figure 2. Prosthesis in place.
Figure 3
Figure 3. Control duplex scan.
Figure 4
Figure 4. Complications.
Figura 1
Figura 1. Prótese antes do implante.
Figura 2
Figura 2. Prótese implantada.
Figura 3
Figura 3. Doppler de controle.
Figura 4
Figura 4. Complicações.
See this image and copyright information in PMC

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