Heparin-Bonded Polytetrafluorethylene Does Not Improve Hemodialysis Arteriovenous Graft Function

Ann Vasc Surg. 2016 Jan;30:28-33. doi: 10.1016/j.avsg.2015.06.071. Epub 2015 Aug 6.

Abstract

Background: Heparin-bonded polytetrafluorethylene (hep PTFE), when compared with standard PTFE, has been shown to have a modest improvement in distal extremity bypass grafts. The data supporting its usage for dialysis access are less clear. We compared the patency rates, number of interventions, and complications between hep PTFE grafts and nonheparin-bonded PTFE (nonhep PTFE) grafts placed for dialysis access.

Methods: A retrospective review of all dialysis access procedures between January 2013 and March 2014 entered into a prospectively maintained vascular surgery database was performed. Our primary end point was functional graft patency. Secondary end points were primary, primary assisted, and secondary patency, as well as time to graft abandonment, and number of procedures required to maintain or restore graft patency. The number of interventions required to maintain graft patency and graft-related complications were also reviewed. Kaplan-Meier curves were used to compare the 2 groups.

Results: Between January 2013 and March 2014, 301-dialysis access procedures were performed, which included 70 arteriovenous grafts (AVGs) comprised 32 hep PTFE (32, 6-mm straight grafts) and 38 nonhep PTFE (35, 4-7-mm taper and 3, 6-mm straight). Mean follow-up was 7.35 ± 5.15 months. At 1 year, Kaplan-Meier survival curves showed that functional patency between hep PTFE and nonhep PTFE AVG were 60% and 75%, respectively (P = 0.37). Primary and secondary patencies were not significantly different between groups; however, primary-assisted patency was significantly improved at 1 year (hep PTFE versus nonhep PTFE: 50% vs. 80%; P = 0.02). The number of hep PTFE grafts undergoing percutaneous thrombectomy was significantly higher than the nonhep PTFE grafts (11 vs. 2; P = 0.009). The incidence and time to graft abandonment were not statistically different. The same was true for the number of complications between the 2 groups. Multivariate analysis showed nonhep PTFE AVG to be advantageous for primary and primary-assisted patency.

Conclusions: We did not demonstrate a benefit to the routine use of hep PTFE for AVG creation especially given the higher cost of these grafts. Functional patency rates were not improved, and the rates of reintervention and thrombectomy were higher with hep PTFE AVGs.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical*
  • Coated Materials, Biocompatible
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Graft Occlusion, Vascular / prevention & control
  • Heparin / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Polytetrafluoroethylene*
  • Prosthesis Design*
  • Renal Dialysis*
  • Renal Insufficiency / therapy
  • Retrospective Studies
  • Vascular Patency

Substances

  • Coated Materials, Biocompatible
  • Fibrinolytic Agents
  • Polytetrafluoroethylene
  • Heparin