title: Early Experience With a Novel Hybrid Vascular Graft for Hemodialysis Access Creation in Patients With Disadvantaged Anatomy.
abstract: OBJECTIVE
  To describe the use of the Hybrid vascular graft in disadvantaged anatomy for hemodialysis access creation and compare outcomes to standard-wall polytetrafluoroethylene (PTFE) grafts.
  
  
  METHODS
  In a retrospective analysis, 25 patients (mean age 65±14 years; 13 men) who received the Hybrid graft were compared with 35 contemporaneous patients (mean age 63±12 years; 20 men) who received a standard PTFE graft for hemodialysis access over a 2-year period. Criteria for Hybrid graft placement were (1) exhausted or inadequate peripheral veins for arteriovenous fistula (AVF) creation and concomitant small target veins that precluded conventional PTFE graft placement, (2) previous graft anastomosis or a stent in the venous target at the level of the axilla, or (3) failed brachial-basilic or brachial-brachial upper arm transposition AVF with a small target vein at the axilla. Efficacy, anatomic and clinical considerations, and technique were reviewed; patency rates, complications, and reinterventions were examined.
  
  
  RESULTS
  Technical success was achieved in all cases, and all grafts were usable for hemodialysis. Seven of 25 Hybrid patients required stent-graft extensions and 3 patients required angioplasty to improve venous outflow at the time of Hybrid graft insertion. Three of 35 standard PTFE graft patients required angioplasty to improve venous outflow at the time of graft insertion. There was no perioperative mortality or procedure-related morbidity in either group. Median follow-up was 21 months. The patient survival estimate was 66% at 2 years. Estimated primary patency (24% vs 18%, p>0.05), assisted primary patency (34% vs 28%; p>0.05), and secondary patency rates (40% vs 38%, p≥0.05) at 24 months were equivalent for Hybrid vs PTFE grafts, respectively. Venous hypertension was not a complication following Hybrid graft implantation but was seen in 2 patients with the standard PTFE graft.
  
  
  CONCLUSIONS
  The Hybrid graft offers a safe, technically effective alternative for patients with disadvantaged anatomy requiring hemodialysis access and has comparable outcomes to standard PTFE grafts. Further clinical experience and long-term data are required for determining the proper utility of this device in chronic dialysis-dependent patients.
authors.affiliation: Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, TX, USA daviesm@uthscsa.edu.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.affiliation: Division of Vascular Diseases and Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El-Sayed
authors.affiliation: Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden
authors.affiliation: Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Naoum
mesh_terms: D000368:Aged; D017130:Angioplasty; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene
keywords: arteriovenous fistula; dialysis access; hemodialysis; hybrid graft; patency; polytetrafluoroethylene graft