Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access

Abstract

Objective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephal-ic and brachio-cephalic fistula.Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29)or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultra-sonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test wasused for estimation and comparison of the patency.Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients(52%). Primary patency rate was 93% in 12 th month and 82% in 24 th month in SVI group while it was 88% in 12 th month and 56% in 24th month inPTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared toPTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12 thmonth and 93% in 24 th month for SVI group while 96% in 12 th month and 84% in 24th month for PTFE group. According to the Kaplan-Meiermethod, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40months, Log Rank chi-square value: 7.33, df:1, p=0.007).Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and second-ary patency, lower complication rate and cost when compared with PTFE grafts.