title: A prospective randomized study of heparin-bonded graft (Propaten) versus standard graft in prosthetic arteriovenous access.
abstract: OBJECTIVE
  Prosthetic grafts continue to be required for hemodialysis access when the options for native fistulas have been exhausted. The inferior long-term patency of grafts makes the possibility of preventing occlusion with heparin-bonded grafts an attractive alternative. We carried out a prospective randomized study to compare the patency of standard grafts with heparin-bonded grafts.
  
  
  METHODS
  Patients with end-stage renal failure requiring a prosthetic access were randomized to receive either a standard expanded polytetrafluorethylene (ePTFE) graft or a heparin-bonded ePTFE graft. Patients were enrolled from June 2007 until November 2011 and were followed up until July 2013, when the study concluded.
  
  
  RESULTS
  In this study, 160 patients were randomized and followed up for a median of 23.5 months. No patient was lost to follow-up. Primary patency was 35% and 14% for heparin-bonded grafts and 29% and 12% for standard ePTFE grafts at 6 and 12 months, respectively (P = .48). Assisted primary patency was 54%, 41%, and 27% for heparin-bonded grafts and 41%, 30%, and 23% for standard grafts at 12, 24, and 36 months, respectively (P = .12). Secondary patency was 83%, 83%, and 81% for heparin-bonded grafts and 81%, 73%, and 68% for standard grafts at 12, 24, and 36 months, respectively (P = .33). There were significantly fewer thromboses in heparin-bonded grafts during the first 5 months (P = .020). Of 80 standard grafts, 24 were eventually abandoned vs 17 heparin-bonded grafts (P = .188). Bleeding complications, infections, and intervention rates were similar in both groups.
  
  
  CONCLUSIONS
  Heparin-bonded grafts demonstrated a trend to improved patency, but the difference was not statistically significant. Heparin-bonded grafts had a significantly lower early thrombosis rate that was sustained only for the first 5 months of follow-up.
authors.affiliation: Department of Surgery, Hemodialysis Access Center, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel. Electronic address: shemeshd@szmc.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Shemesh
authors.affiliation: Department of Surgery, Hemodialysis Access Center, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Goldin
authors.affiliation: Department of Surgery, Hemodialysis Access Center, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Jamal
authors.initials: J
authors.lastname: Hijazi
authors.affiliation: Department of Radiology, Interventional Radiology Unit, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Zaghal
authors.affiliation: Department of Radiology, Interventional Radiology Unit, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berelowitz
authors.affiliation: Department of Radiology, Interventional Radiology Unit, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Anthony
authors.initials: A
authors.lastname: Verstandig
authors.affiliation: Department of Surgery, Hemodialysis Access Center, Shaare Zedek Medical Center (affiliated with the Faculty of Health Sciences, Hebrew University), Jerusalem, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Olsha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007557:Israel; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D011474:Prosthesis Design; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin