The graft selection for haemodialysis

In patients with chronic renal failure, a major concern is to provide safe and reliable long-term vascular access for haemodialysis. The radiocephalic arteriovenous (AV) fistula remains the first choice vascular access procedure, however the grafts are used in order to obtain vascular access in patients with failed native distal and proximal AV fistulas. The aim of this study was to compare the patency rate of different grafts such as standard wall polytetrafluoroethylene (sPTFE), bovine vein graft, Diastat graft, in these patients.

Four hundred and forty-six AV fistulas were surgically created in 361 patients. Eighty-four out of 361 patients undergoing different graft replacements were retrospectively reviewed. We evaluated the primary patency rates, days between the fistula placement and the last dialysis treatment before thrombosis had occurred, and the secondary patency rate, days between the fistula placement and the last dialysis treatment before the graft was considered completely lost. The graft survival was calculated according to the Kaplan-Meier method.

There were 58 (69%) women and 26 (31%) men with a mean age of 54.5 years. The sPTFE (Gore-Tex) graft was used in 41 (41.8%), bovine vein graft (ProCol) in 38 (38.7%) and Diastat vascular grafts in 19 (19.5%) patients. Primary and secondary patency rates for sPTFE graft were 37% and 60%, 68% and 85% for bovine graft and 26% and 42% for Diastat vascular grafts, respectively.

This study demonstrates that the bovine vein graft provides the longest patency rate compared to the other grafts even in patients with multiple failed accesses.