title: An Outcomes Comparison of Native Arteriovenous Fistulae, Polytetrafluorethylene Grafts, and Cryopreserved Vein Allografts.
abstract: BACKGROUND
  Despite almost 2 decades of experience with cadaveric vein, there remains a paucity of available data regarding the role of cadaveric vein in hemodialysis, specifically with regard to outcomes and patency. Observations from our own experience have suggested that cadaveric vein grafts (CVGs) provide good outcomes, particularly in patients with recurrent access failure. Accordingly, this study aims to comparatively examine patency, access-related outcomes, and survival in patients undergoing placement of arteriovenous fistulae (AVF), polytetrafluorethylene (PTFE) grafts, and CVGs.
  
  
  METHODS
  This is a single institution 11-year retrospective case series evaluating the outcomes of 210 patients who underwent creation of AVF, PTFE grafts, and CVGs for hemodialysis access. Patients in the AVF (n = 70) and arteriovenous graft (AVG; n = 70) groups were matched to the CVG (n = 70) group by age, gender, and access location. Postoperative end points for all groups included primary and assisted patency, cause of access abandonment, and survival.
  
  
  RESULTS
  Patients were matched for age (P = 0.8707), gender (P = 0.6958), and access location and no significant differences existed between groups. AVF showed superior primary patency at 30 days, 1 year (64.3%, P < 0.0001) and 2 years (54.3%, P = 0.0091) in comparison to both AVG and CVG. AVG had reduced patency at 30 days (84.3%, P = 0.0009), 1 year (50.0%, P < 0.0001), and 2 years (32.9%, P = 0.0001) in comparison to AVF and CVG groups. Overall, AVF had the highest patency at all-time points followed, respectively by CVG and AVG. No significant difference existed between AVF and CVG groups with regard to secondary patency at 30 days (98.6% vs. 97.1%, P = 1.0000), 1 year (81.4% vs. 78.6%, P = 0.6749), and 2 years (68.6% vs. 51.4%, P = 0.0573). AVG patients had decreased survival (years) after access creation in comparison to AVF and CVG groups (P = 0.0003).
  
  
  CONCLUSIONS
  Our findings lend further support to the use of cadaveric vein for hemodialysis access surgery. As demonstrated through this comparative study, CVGs are capable of providing favorable results with regard to patency, access longevity, and patient survival. These current outcomes indicate that cadaveric vein is a sustainable alternative to PTFE for hemodialysis access surgery and should be accordingly considered for difficult access patients.
authors: Department of Surgery, University of Connecticut Integrated General Surgery Residency Program, Farmington, CT. Electronic address: cjadlowiec@uchc.edu.
authors: Caroline C
authors: CC
authors: Jadlowiec
authors: Department of Surgery, Hartford Hospital, Summer Student Pre-Med and Research Program, Hartford, CT.
authors: Matthew
authors: M
authors: Lavallee
authors: Department of Surgery, The University of Connecticut School of Medicine, Farmington, CT.
authors: Elizabeth M
authors: EM
authors: Mannion
authors: Division of Transplant, Department of Surgery, Hartford Hospital, Hartford, CT.
authors: Matthew G
authors: MG
authors: Brown
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D002102:Cadaver; D015925:Cryopreservation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene