Vascular access for dialysis. Technics and results with newer methods

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Device Technology

Background:

• Secondary surgical procedures are crucial for maintaining hemodialysis access in patients with failing primary sites.
• The study population exhibited unique characteristics, including a higher prevalence of females, diabetes, and collagen-vascular diseases compared to the general dialysis population.

Purpose of the Study:

• To compare the durability and complication rates of three secondary hemodialysis access techniques: Thomas femoral shunt, saphenous vein graft, and Sparks mandril graft.
• To identify the most suitable secondary access option based on longevity and clinical outcomes.

Main Methods:

• A retrospective analysis of 114 patients undergoing secondary access operations over five years.
• Life table analysis was employed to compare the duration of utility for each type of graft.
• Patient demographics and complication incidence, particularly septic complications, were recorded and analyzed.

Main Results:

• The Thomas femoral shunt demonstrated the longest duration of utility but was associated with a high incidence of septic complications.
• The Sparks mandril graft showed intermediate durability and utility.
• The saphenous vein graft was found to be the least durable in clinical use.

Conclusions:

• The Sparks mandril graft is tentatively recommended as a primary choice for secondary hemodialysis access, provided sufficient maturation time is available.
• The choice of secondary access should balance the need for longevity with the risk of complications, such as sepsis associated with femoral shunts.