Australian Multicentre Evaluation of a New Polyurethane Vascular Access Graft

Abstract

Background:A new three-layered cast polyurethane vascular access graft (Thoratec@ VAG) is the most recent addition to the list of materials used in the search for the perfect prosthetic graft material for haemodialysis vascular access. Despite its use in 23 countries, a clinical assessment has not been published. Methods: An independent retrospective evaluation by questionnaire was obtained for 145 implantation procedures performed by 30 surgeons. Results: Ninety-two per cent of procedures were performed for an acute need for vascular access and 73% had prior failed vascular access surgery. Patients were hospitalized for a median of 4 days and the graft was initially used at a median of 3 days. Median follow-up was 306 days. Thoratec@ VAG had a problem-free (primary) patency of 44.9% and a functional (secondary) patency 64.5% at 1 year. Major causes of graft loss were thrombosis (17%) and infection (1 1%).Intra-operative thrombosis was the only significant risk factor for subsequent thrombosis (P = 0.013). Infection was less in patients with antibiotic prophylaxis that included vancomycin (P = 0.02). Conclusion:The ability to use the graft soon after surgery is a major advance for patients who urgently need reliable medium to long-term haemodialysis access.

Polyurethane Grafts: A Viable Alternative for Dialysis Arteriovenous Access?

“…5 These rates are comparable to those of ePTFE grafts at 1 year of 77% (primary) and 64% (secondary). 7,8,[13][14][15] The 3-year primary and secondary patency rates in our study of 55% and 72%, respectively, fall within the standards set by the National Kidney Foundation, 16 which recommends that the cumulative patency rates of all dialysis AV grafts should be at least 70% at 1 year, 60% at 2 years, and 50% at 3 years.…”

“…Moreover, upper arm grafts should pose a lower risk of thrombosis than do forearm grafts as the vessels there are larger with higher flow rates. However, this study as well as others 5,8 did not show any differences in the thrombosis rates in these patient groups.…”

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

“…According to this study, a problem-free (primary) and functional (secondary) patency was reported in 44.9% and 64.5% of the patients, respectively. 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).…”

Vascular Access

“…Subsequent studies in the late 1970s suggested that ePTFE was equal to or better than other available synthetic grafts or biografts in terms of long-term patency and had an acceptable complication rate; hence ePTFE rapidly became the preferred choice of many surgeons as graft material for secondary arteriovenous access in hemodialysis patients. [86][87][88][89][90] Although problems have been reported with some of the polyurethane graft designs, 87,89,90 recent studies have suggested that the polyurethane Vectra graft (Thoratec Lab Corp, CA) is comparable to ePFTE in terms of patency and complications. Both types of ePTFE graft have similar pore size but the Gore-Tex brand is thicker and is reinforced by an external circumferential layer of PTFE not used in Impra grafts.…”