title: Experience with cryopreserved cadaveric femoral vein allografts used for hemodialysis access.
abstract: The purpose of this study was to review the patency and complications of cryopreserved vein allografts used for hemodialysis access, and to compare them to a group with polytetrafluoroethylene (PTFE) grafts. Patients without adequate vasculature for native fistula were implanted with vein allografts or PTFE grafts at the surgeon's discretion. Only cryopreserved (CRY) veins were used until January 2001, when decellularized, cryopreserved Synergraft (SYN) veins became available. The CRY group had 48 patients; the SYN group, 42 patients; the PTFE group, 100 patients, who were selected from billing records listing PTFE graft insertion. Patient demographics were similar. Primary and secondary patencies were not significantly different at 1 or 2 years between groups. Complications in PTFE versus CRY and SYN groups were as follows: infection, 10 % vs. 0% (p < 0.01); aneurysm, 2% vs. 18% (p < 0.001); and steal syndrome, 12% vs. 12% (p = NS). Significantly more vein allograft patients lost their accesses to aneurysm (p < 0.01) and multiple stenoses (p < 0.05), whereas PTFE patients lost significantly more accesses to infection (p < 0.01) and recurrent thrombosis (p < 0.05). We conclude that cadaver vein allografts have similar patency to PTFE grafts. These allografts are more resistant to infection but significantly more susceptible to aneurysms. When used, vein allografts should be monitored aggressively for the development of aneurysms.
authors.affiliation: Department of Surgery, Transplant Division, Baystate Medical Center, Springfield, MA, USA. robert.madden@bhs.org
authors.forename: Robert L
authors.initials: RL
authors.lastname: Madden
authors.forename: George S
authors.initials: GS
authors.lastname: Lipkowitz
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Browne
authors.forename: Alexander
authors.initials: A
authors.lastname: Kurbanov
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002102:Cadaver; D016022:Case-Control Studies; D015925:Cryopreservation; D005260:Female; D005268:Femoral Vein / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene