Editor's Choice - Outcomes of Cold Stored Saphenous Vein Allografts for Haemodialysis Vascular Access

Area of Science:

• Vascular Surgery
• Nephrology
• Biomaterials Science

Background:

• Patients requiring hemodialysis often face challenges with vascular access creation due to exhausted venous capital.
• Autogenous arteriovenous fistulas are preferred but not always feasible.
• Alternative vascular access options are crucial for long-term hemodialysis management.

Purpose of the Study:

• To evaluate the clinical outcomes of cold stored saphenous vein allografts (CSVAs) used for hemodialysis vascular access.
• To analyze patency rates, complications, and re-intervention needs associated with CSVA.
• To compare CSVA performance against existing vascular access modalities.

Main Methods:

• A retrospective, two-center study included 109 patients undergoing CSVA placement for hemodialysis.
• Data collected from January 2016 to December 2020.
• Analysis focused on primary, primary assisted, and secondary patency, procedural complications, and re-interventions.

Main Results:

• One-year patency rates: primary 37.6%, primary assisted 59.0%, secondary 73.3%. Two-year rates: primary 19.9%, primary assisted 42.5%, secondary 54.9%.
• Low access infection rate (4.6%) with no related mortality.
• High rates of stenosis (57.8%) and thrombosis (49.5%) observed during follow-up.

Conclusions:

• Cold stored saphenous vein allografts (CSVAs) present a potential alternative to synthetic grafts for hemodialysis vascular access.
• CSVAs demonstrate comparable patency and low infection rates, particularly beneficial when venous capital is depleted.
• Consideration of patient-specific risk factors is important for optimizing CSVA outcomes.