A Polyurethane Vascular Access Graft and a Hybrid Polytetrafluoroethylene Graft as an Arteriovenous Fistula for Hemodialysis: Comparison with an Expanded Polytetrafluoroethylene Graft

Matsuda, Hiroaki; Miyazaki, Masashi; Oka, Yoshinari; Nakao, Atsunori; Choda, Yasuhiro; Kokumai, Yoshiaki; Kunitomo, Keiichi; Tanaka, Noriaki

doi:10.1046/j.1525-1594.2003.07031.x

Cited by 22 publications

(16 citation statements)

References 7 publications

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“…We found that both thrombosis‐free graft survival and cumulative graft survival were similar to those obtained with conventional PTFE grafts. This finding is in keeping with previous studies comparing the two graft types (1,3). In contrast, the cumulative risk of infection was substantially higher with polyurethane grafts than with PTFE grafts, particularly in the subset placed in the thigh.…”

Section: Discussionsupporting

confidence: 93%

“…Since enrollment in the randomized study was limited to patients receiving an upper extremity graft (1), it is not clear whether its conclusions can be generalized to polyurethane grafts placed in the thigh. Other published series of polyurethane grafts have reported an infection rate of 3–30% (3–7). These studies varied in the proportion of patients receiving thigh grafts and in the time to first graft cannulation, and lacked appropriate control patients with PTFE grafts.…”

mentioning

confidence: 99%

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Increased Risk of Infection Associated with Polyurethane Dialysis Grafts

Maya

Weatherspoon

Young

et al. 2007

Seminars in Dialysis

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Conventional polytetrafluoroethylene (PTFE) dialysis grafts cannot be cannulated for 2-3 weeks following their creation. Polyurethane grafts, made of a self-sealing material, can be cannulated within 24 hours of implantation, representing a potential advantage in patients with limited catheter options. However, early cannulation may increase the risk of graft infection. We retrospectively queried a prospective, computerized access database to identify 31 patients receiving a polyurethane graft, and 56 date-matched controls with a PTFE graft. Survival techniques were used to plot graft survival. Thrombosis-free graft survival (from creation to first thrombosis or failure) was similar for polyurethane and PTFE grafts (1-year survival, 28%, vs. 32%, p = 0.98). Cumulative graft survival (from creation to permanent failure) was also similar (1-year survival 42% vs. 52%, p = 0.40). Finally, the cumulative risk of graft infection was 37.5% for polyurethane thigh grafts, 23% for polyurethane upper extremity grafts, 21% for PTFE thigh grafts, and 5% for PTFE upper extremity grafts (p = 0.06 for polyurethane vs. PTFE grafts). The likelihood of thrombosis and failure is similar for polyurethane and PTFE grafts. However, polyurethane grafts may have a higher risk of infection, particularly when they are placed in the thigh. In patients with an access emergency, implantation of a polyurethane graft incurs a tradeoff between earlier cannulation and a higher risk of infection.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Increased Risk of Infection Associated with Polyurethane Dialysis Grafts

Maya

Weatherspoon

Young

et al. 2007

Seminars in Dialysis

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“…On the other hand, Matsuda et al experienced few thromboses using PTFE. Primary patency rate was also reported to be significantly better in the group with PTFE; however, there was no considerable difference in the secondary patency rate of the two grafts (19). Glickman et al, conversely, demonstrated the PVAG grafts to have similar patency and efficacy when compared with the PTFE grafts in dialysis patients.…”

Section: Discussionmentioning

confidence: 92%

“…It was concluded that PVAG is the graft of choice in patients requiring an urgent, reliable, medium- to long-term hemodialysis access (18). On the contrary, other studies have shown PTFE to be an efficient vascular access for hemodialysis where a primary fistula or brachio-basilic transplantation is not possible (6,17,19). Modarai et al, however, reported a poor patency rate and a high risk of complication (infection and thrombosis) using this graft (20).…”

Section: Discussionmentioning

confidence: 94%

Patency rate and complications of polytetrafluoroethylene grafts compared with polyurethane grafts for hemodialysis access

Ravari

Kazemzade

Modaghegh

et al. 2010

Upsala Journal of Medical Sciences

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BackgroundThe survival of hemodialysis patients requiring dialysis depends on the long-term functioning and patency of the vascular access. Prosthetic vascular grafts are inevitably used for patients whose vessels are unsuitable for an autogenous arteriovenous (AV) fistula. The purpose of this study was to compare the patency rate and associated complications using different types of grafts.MethodsThis prospective study was conducted on patients who did not have an appropriate vein for arteriovenous fistula from January 2004 through July 2006. They were divided into two groups, sex, age, and basic data matched. Polytetrafluoroethylene (PTFE) and polyurethane (PVAG) were the two types of grafts used in this study. The functionality of the graft was assessed immediately 1 day and 2 weeks after operation. The clinical follow-up was performed each 3 months until 24 months.ResultsOne-year patency rate was reported to be 64% and 52% in the PTFE and PVAG groups, respectively. There was no significant difference in 1-year (64% versus 52%) and 2-year (49% versus 41%) patency rate of the PTFE and PVAG grafts used as vascular access. There was also no difference between the numbers of complications reported in the two groups.ConclusionIt could be concluded that either PTFE or PVAG grafts can be used with the same expected outcomes.

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“…11 Because perigraft edema occurs in almost all cases of ePTFE graft implantation, the first puncture of a graft is routinely started more than 14 days after implantation. 12 Therefore, the implantation of paclitaxel-coated vascular grafts may significantly reduce morbidities and provide a novel advantage for early first punctures of grafts through prevention of perigraft edema.…”

Section: E F) the Number Of Inflammatory Cells Was Greater In Samplmentioning

confidence: 99%

Paclitaxel Coating Inhibits Inflammation Surrounding Subcutaneously Implanted Expanded Polytetrafluoroethylene (ePTFE) Hemodialysis Grafts in Rabbit Model

Baek¹,

Lee²,

Park³

et al. 2010

Bulletin of the Korean Chemical Society

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Hemodialysis vascular access dysfunction (HVAD) due to the aggressive development of venous neointimal hyperplasia remains a major complication for patients with synthetic arteriovenous grafts. Paclitaxel-coated expanded polytetrafluoroethylene (ePTFE) grafts effectively prevent neointimal hyperplasia and stenosis. However, perigraft inflammation or edema can be another complication of ePTFE grafts, preventing early cannulation. Three different types of ePTFE grafts, including grafts without paclitaxel coating (control group, n = 12), grafts with paclitaxel coating at a dose density of 0.61 ug/mm 2 (low concentration group, n = 12), and grafts with paclitaxel coating at a dose density of 1.15 ug/mm 2 (high concentration group, n = 12) were placed in the backs of 12 rabbits, simultaneously. Six rabbits were euthanized after one week and the remaining six were euthanized two weeks after implantation. Perigraft inflammation, graft wall inflammation, stromal cell proliferation, blood vessel formation, tissue necrosis and edema were analyzed for the grafts in each animal. Inflammation surrounding the paclitaxel-coated grafts was significantly reduced compared to the control group. Stromal cell layers were detected at the interface between the graft and the surrounding tissue in the control group, infiltrated into the graft interstices, and differentiated into myofibroblasts for graft healing. Paclitaxel-coated grafts inhibited stromal cell proliferation and infiltration into the graft wall. Tissue necrosis and edema were not detected in either of the paclitaxel-coated graft groups.

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A Polyurethane Vascular Access Graft and a Hybrid Polytetrafluoroethylene Graft as an Arteriovenous Fistula for Hemodialysis: Comparison with an Expanded Polytetrafluoroethylene Graft

Abstract: The hPTFEG was considered superior to ePTFEG in terms of being complication-free and had the excellent 2 year secondary patency of 90.9%. TVAG, with a patency equal to that of ePTFEG, could be used immediately after implantation due to the absence of limb edema.

Cited by 22 publications

References 7 publications

Increased Risk of Infection Associated with Polyurethane Dialysis Grafts

Increased Risk of Infection Associated with Polyurethane Dialysis Grafts

Patency rate and complications of polytetrafluoroethylene grafts compared with polyurethane grafts for hemodialysis access

Paclitaxel Coating Inhibits Inflammation Surrounding Subcutaneously Implanted Expanded Polytetrafluoroethylene (ePTFE) Hemodialysis Grafts in Rabbit Model

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