Heparin bonded hemodialysis e-PTFE grafts result in 20% clot free survival benefit.
Luminal surface heparin bonded hemodialysis e-PTFE grafts (N=83) with prolonged bioactivity retention (CBAS technology) were compared to 67 control e-PTFE grafts using Kaplan-Meier survival curve estimates. Log-rank tests were used for statistical comparisons between groups. Heparin bonded graft recipients were on average 3.5 years older (NS), and had upper arm grafts in 66% vs. 43% (p=0.003) compared to controls. There was no clot-free survival (CFS) difference between groups for upper arm vs. forearm placed grafts (p=0.792). Patient mortality at one year was 15%, with no group difference. The overall combined clot-free survival for all 150 e-PTFE grafts was 69% at 12 months. At 6 and 12 months, CFS for the heparin bonded graft group was 88% and 78%, which is significantly higher than that of 69% and 58% for the control group, respectively, (p=0.007). It is concluded that heparin binding technology to artificial surfaces has evolved to a clinically powerful technique for the hemodialysis patient resulting in a 20% improved primary graft patency of about 80% at one year.
Davidson
Ingemar
I
Departments of Surgery and Clinical Sciences, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, Dallas TX 75390-8567, USA. ingemar.davidson@UTSouthwestern.edu
Hackerman
Clayton
C
Kapadia
Aschmeeta
A
Minhajuddib
Abu
A
D000925:Anticoagulants / Q000008:administration & dosage*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016022:Case-Control Studies; D020099:Coated Materials, Biocompatible; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin