Bovine carotid artery xenografts for hemodialysis access
Abstract Objective Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report...
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| Veröffentlicht in: | Journal of vascular surgery 2017-06, Vol.65 (6), p.1729-1734 |
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| creator | Pineda, Danielle M., MD Dougherty, Matthew J., MD Wismer, Michael C., BA Carroll, Chelsea, DO Tyagi, Samuel, MD Troutman, Douglas A., DO Calligaro, Keith D., MD |
| description | Abstract Objective Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency. Methods We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method. Results For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency ( P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or |
| doi_str_mv | 10.1016/j.jvs.2016.12.109 |
| format | Article |
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However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency. Methods We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method. Results For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency ( P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or <30 ( P = .85, P = .54). Patients who had a BCA graft as their first access attempt had a higher primary and primary assisted patency than that of patients who had the graft placed after prior access failure ( P = .039, P = .024). Conclusions This represents the largest published series of BCA grafts for arteriovenous grafts in the modern era. The primary patency of BCA grafts in this series was lower than that reported in a smaller randomized study. However, primary assisted and secondary patency were similar. Infection rates in this series appear to be somewhat lower than polytetrafluoroethylene infection rates reported in the literature. BCA grafts are a satisfactory alternative to expanded polytetrafluoroethylene for hemodialysis access, but larger controlled studies are needed to determine whether superior primary patency previously reported is a reproducible finding.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.12.109</identifier><identifier>PMID: 28366301</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Animals ; Arteriovenous Shunt, Surgical - adverse effects ; Arteriovenous Shunt, Surgical - instrumentation ; Arteriovenous Shunt, Surgical - methods ; Bioprosthesis ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - methods ; Body Mass Index ; Carotid Arteries - physiopathology ; Carotid Arteries - transplantation ; Cattle ; Female ; Graft Occlusion, Vascular - diagnosis ; Graft Occlusion, Vascular - etiology ; Graft Occlusion, Vascular - physiopathology ; Graft Occlusion, Vascular - therapy ; Heterografts ; Humans ; Kaplan-Meier Estimate ; Male ; Obesity - complications ; Obesity - diagnosis ; Philadelphia ; Renal Dialysis ; Retreatment ; Retrospective Studies ; Risk Factors ; Sex Factors ; Surgery ; Time Factors ; Treatment Outcome ; Vascular Patency</subject><ispartof>Journal of vascular surgery, 2017-06, Vol.65 (6), p.1729-1734</ispartof><rights>Society for Vascular Surgery</rights><rights>2017 Society for Vascular Surgery</rights><rights>Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-2b2ac0769280d9306cadade45eee912c9cf575ca9a1f268eda194995dfecd7563</citedby><cites>FETCH-LOGICAL-c451t-2b2ac0769280d9306cadade45eee912c9cf575ca9a1f268eda194995dfecd7563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2016.12.109$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28366301$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pineda, Danielle M., MD</creatorcontrib><creatorcontrib>Dougherty, Matthew J., MD</creatorcontrib><creatorcontrib>Wismer, Michael C., BA</creatorcontrib><creatorcontrib>Carroll, Chelsea, DO</creatorcontrib><creatorcontrib>Tyagi, Samuel, MD</creatorcontrib><creatorcontrib>Troutman, Douglas A., DO</creatorcontrib><creatorcontrib>Calligaro, Keith D., MD</creatorcontrib><title>Bovine carotid artery xenografts for hemodialysis access</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Abstract Objective Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency. Methods We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method. Results For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency ( P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or <30 ( P = .85, P = .54). Patients who had a BCA graft as their first access attempt had a higher primary and primary assisted patency than that of patients who had the graft placed after prior access failure ( P = .039, P = .024). Conclusions This represents the largest published series of BCA grafts for arteriovenous grafts in the modern era. The primary patency of BCA grafts in this series was lower than that reported in a smaller randomized study. However, primary assisted and secondary patency were similar. Infection rates in this series appear to be somewhat lower than polytetrafluoroethylene infection rates reported in the literature. BCA grafts are a satisfactory alternative to expanded polytetrafluoroethylene for hemodialysis access, but larger controlled studies are needed to determine whether superior primary patency previously reported is a reproducible finding.</description><subject>Animals</subject><subject>Arteriovenous Shunt, Surgical - adverse effects</subject><subject>Arteriovenous Shunt, Surgical - instrumentation</subject><subject>Arteriovenous Shunt, Surgical - methods</subject><subject>Bioprosthesis</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Body Mass Index</subject><subject>Carotid Arteries - physiopathology</subject><subject>Carotid Arteries - transplantation</subject><subject>Cattle</subject><subject>Female</subject><subject>Graft Occlusion, Vascular - diagnosis</subject><subject>Graft Occlusion, Vascular - etiology</subject><subject>Graft Occlusion, Vascular - physiopathology</subject><subject>Graft Occlusion, Vascular - therapy</subject><subject>Heterografts</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Obesity - complications</subject><subject>Obesity - diagnosis</subject><subject>Philadelphia</subject><subject>Renal Dialysis</subject><subject>Retreatment</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Patency</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rHDEMhk1paTZJf0AvZY69zMbyfNkUCk3IRyHQQxLIzTiypvV0dpxas0v238fLpj3k0IskxPu-oEdCfAS5BAntybAcNrxUeVyCyivzRixy7cpWS_NWLGRXQ9koqA_EIfMgJUCju_fiQOmqbSsJC6FP4yZMVKBLcQ6-cGmmtC2eaIo_k-tnLvqYil-0ij64ccuBC4dIzMfiXe9Gpg8v_UjcXZzfnl2V1z8uv599uy6xbmAu1YNyKLvWKC29qWSLzjtPdUNEBhQa7JuuQWcc9KrV5B2Y2pjG94S-a9rqSHze5z6m-GdNPNtVYKRxdBPFNVvQutJ1RiCzFPZSTJE5UW8fU1i5tLUg7Q6YHWwGZnfALKi8Mtnz6SV-_bAi_8_xl1AWfNkLKB-5CZQsY6AJyYdEOFsfw3_jv75y4ximgG78TVviIa7TlOlZsKystDe7j-0eBl0lpTH31TN-1pDZ</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Pineda, Danielle M., MD</creator><creator>Dougherty, Matthew J., MD</creator><creator>Wismer, Michael C., BA</creator><creator>Carroll, Chelsea, DO</creator><creator>Tyagi, Samuel, MD</creator><creator>Troutman, Douglas A., DO</creator><creator>Calligaro, Keith D., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Bovine carotid artery xenografts for hemodialysis access</title><author>Pineda, Danielle M., MD ; Dougherty, Matthew J., MD ; Wismer, Michael C., BA ; Carroll, Chelsea, DO ; Tyagi, Samuel, MD ; Troutman, Douglas A., DO ; Calligaro, Keith D., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-2b2ac0769280d9306cadade45eee912c9cf575ca9a1f268eda194995dfecd7563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Animals</topic><topic>Arteriovenous Shunt, Surgical - adverse effects</topic><topic>Arteriovenous Shunt, Surgical - instrumentation</topic><topic>Arteriovenous Shunt, Surgical - methods</topic><topic>Bioprosthesis</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Body Mass Index</topic><topic>Carotid Arteries - physiopathology</topic><topic>Carotid Arteries - transplantation</topic><topic>Cattle</topic><topic>Female</topic><topic>Graft Occlusion, Vascular - diagnosis</topic><topic>Graft Occlusion, Vascular - etiology</topic><topic>Graft Occlusion, Vascular - physiopathology</topic><topic>Graft Occlusion, Vascular - therapy</topic><topic>Heterografts</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Obesity - complications</topic><topic>Obesity - diagnosis</topic><topic>Philadelphia</topic><topic>Renal Dialysis</topic><topic>Retreatment</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pineda, Danielle M., MD</creatorcontrib><creatorcontrib>Dougherty, Matthew J., MD</creatorcontrib><creatorcontrib>Wismer, Michael C., BA</creatorcontrib><creatorcontrib>Carroll, Chelsea, DO</creatorcontrib><creatorcontrib>Tyagi, Samuel, MD</creatorcontrib><creatorcontrib>Troutman, Douglas A., DO</creatorcontrib><creatorcontrib>Calligaro, Keith D., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pineda, Danielle M., MD</au><au>Dougherty, Matthew J., MD</au><au>Wismer, Michael C., BA</au><au>Carroll, Chelsea, DO</au><au>Tyagi, Samuel, MD</au><au>Troutman, Douglas A., DO</au><au>Calligaro, Keith D., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bovine carotid artery xenografts for hemodialysis access</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>65</volume><issue>6</issue><spage>1729</spage><epage>1734</epage><pages>1729-1734</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Abstract Objective Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency. Methods We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method. Results For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency ( P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or <30 ( P = .85, P = .54). Patients who had a BCA graft as their first access attempt had a higher primary and primary assisted patency than that of patients who had the graft placed after prior access failure ( P = .039, P = .024). Conclusions This represents the largest published series of BCA grafts for arteriovenous grafts in the modern era. The primary patency of BCA grafts in this series was lower than that reported in a smaller randomized study. However, primary assisted and secondary patency were similar. Infection rates in this series appear to be somewhat lower than polytetrafluoroethylene infection rates reported in the literature. BCA grafts are a satisfactory alternative to expanded polytetrafluoroethylene for hemodialysis access, but larger controlled studies are needed to determine whether superior primary patency previously reported is a reproducible finding.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28366301</pmid><doi>10.1016/j.jvs.2016.12.109</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Animals Arteriovenous Shunt, Surgical - adverse effects Arteriovenous Shunt, Surgical - instrumentation Arteriovenous Shunt, Surgical - methods Bioprosthesis Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - methods Body Mass Index Carotid Arteries - physiopathology Carotid Arteries - transplantation Cattle Female Graft Occlusion, Vascular - diagnosis Graft Occlusion, Vascular - etiology Graft Occlusion, Vascular - physiopathology Graft Occlusion, Vascular - therapy Heterografts Humans Kaplan-Meier Estimate Male Obesity - complications Obesity - diagnosis Philadelphia Renal Dialysis Retreatment Retrospective Studies Risk Factors Sex Factors Surgery Time Factors Treatment Outcome Vascular Patency |
| title | Bovine carotid artery xenografts for hemodialysis access |
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