Clinical Outcomes of Cryopreserved Arterial Allograft Used as a Vascular Conduit for Hemodialysis

다국어 초록 (Multilingual Abstract)

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.

참고문헌 (Reference)

1 Caroli A, "Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients" 84 : 1237-1245, 2013

2 Benedetto B, "Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization" 34 : 139-142, 2001

3 Sidawy AN, "The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access" 48 : 2S-25S, 2008

4 Clark EG, "Temporary hemodialysis catheters : recent advances" 86 : 888-895, 2014

5 Rooijens PP, "Radiocephalic wrist arteriovenous fistula for hemodialysis : meta-analysis indicates a high primary failure rate" 28 : 583-589, 2004

6 Long B, "Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis" 53 : 108-114, 2011

7 Zehr BP, "Limb salvage with CryoVein cadaver saphenous vein allografts used for peripheral arterial bypass : role of blood compatibility" 25 : 177-181, 2011

8 Schmitz-Rixen T, "Immunosuppressive treatment of aortic allografts" 7 : 82-92, 1988

9 Roy-Chaudhury P, "Hemodialysis vascular access dysfunction : a cellular and molecular viewpoint" 17 : 1112-1127, 2006

10 Pegg DE, "Fractures in cryopreserved elastic arteries" 34 : 183-192, 1997

11 Kim HO, "Evaluation of domestic cryostorage blood bags" 17 : 48-53, 2006

12 Kakkos SK, "Equivalent secondary patency rates of upper extremity Vectra Vascular Access Grafts and transposed brachial-basilic fistulas with aggressive access surveillance and endovascular treatment" 47 : 407-414, 2008

13 Walker PJ, "Early experience with cryopreserved saphenous vein allografts as a conduit for complex limb-salvage procedures" 18 : 561-569, 1993

14 Bia D, "Cryopreservation procedure does not modify human carotid homografts mechanical properties : an isobaric and dynamic analysis" 7 : 183-194, 2006

15 Asif A, "Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula" 67 : 2399-2406, 2005

16 Lee T, "Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula" 18 : 1936-1941, 2007

17 Allaire E, "Cell-free arterial grafts: morphologic characteristics of aortic isografts, allografts, and xenografts in rats" 19 : 446-456, 1994

18 Szilagyi DE, "Biologic fate of human arterial homografts" 75 : 506-527, 1957

19 Kieffer E, "Allograft replacement for infrarenal aortic graft infection : early and late results in 179 patients" 39 : 1009-1017, 2004

20 Madden RL, "A comparison of cryopreserved vein allografts and prosthetic grafts for hemodialysis access" 19 : 686-691, 2005