Durability of early prosthetic dialysis graft cannulation: results of a prospective, nonrandomized clinical trial.
OBJECTIVE
Initiation of hemodialysis frequently requires temporary central venous catheterization, which leads to subsequent venous stenosis in 50% of patients. These lesions severely limit upper extremity dialysis fistula creation. The present study was undertaken to determine whether early cannulation (EC) allowed omission of temporary venous catheterization without affecting perioperative morbidity and long-term graft patency.


METHODS
Seventy-nine prosthetic grafts for hemodialysis were placed in 76 patients over a 40-month period. Patients who required hemodialysis between 24 and 72 hours after surgery were assigned to EC. The remaining grafts underwent late cannulation (LC) after postoperative day 14. All grafts were constructed with a 6 mm stretch-expanded polytetrafluoroethylene conduit in the brachial artery-to-axillary vein position. Statistical analysis of cumulative primary patency estimates and patient survival data were determined by Kaplan-Meier analysis and log-rank test, patient variables were compared using chi 2 and Fisher's exact test, and multivariate analysis was performed using Cox's proportional hazard model.


RESULTS
Forty-eight patients underwent EC and 31 underwent LC. There were no significant differences regarding age (mean, 61.5 years), history of diabetes, congestive heart failure, hematocrit level (mean, 30%), or presence of peripheral vascular disease. Thrombosis occurred before cannulation in one of 48 ECs (2.0%) and one of 31 LCs (3.2%). There were no episodes of cannulation hemorrhage or wound infection in either group. Cumulative primary patency estimates for EC were 0.89, 0.82, and 0.70 at 3, 6, and 12 months, respectively. These were not significantly different from the LC estimates of 0.86, 0.78, and 0.74 at 3, 6, and 12 months, respectively. Overall, patients who had a history of peripheral vascular disease had a significantly decreased 12-month patency rate (60% vs 74%; p = 0.05). Central venous catheters were omitted in 47 of 48 EC patients.


CONCLUSIONS
EC of prosthetic dialysis grafts does not increase perioperative morbidity rates or decrease 12-month cumulative primary patency rates.
Hakaim
A G
AG
Department of Surgery, Boston University School of Medicine, MA, USA.
Scott
T E
TE
D001166:Arteriovenous Shunt, Surgical; D001367:Axillary Vein / Q000601:surgery; D001807:Blood Vessel Prosthesis; D001916:Brachial Artery / Q000601:surgery; D002405:Catheterization, Central Venous; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D014654:Vascular Patency
D011138:Polytetrafluoroethylene