title: Equivalent outcomes with standard and heparin-bonded expanded polytetrafluoroethylene grafts used as conduits for hemodialysis access.
abstract: BACKGROUND
  Obtaining and maintaining dialysis access after failure of autologous access sites remains a significant concern for patients on hemodialysis. Polytetrafluoroethylene (PTFE) is the most common conduit used. Heparin-bonded expanded PTFE (HB-PTFE) grafts have recently been introduced as an improved conduit, with suggestions that HB offers benefits because of its resistance to thrombosis. In this retrospective study, the outcomes of HB-PTFE were compared with standard wall PTFE (S-PTFE) arteriovenous grafts (AVGs).
  
  
  METHODS
  From January 2004 to December 2014, 483 adults (46% male; mean age, 60 years; range, 25-87 years) with end-stage renal disease underwent placement of AVGs (234 HB-PTFE and 248 S-PTFE). The two groups did not differ significantly in demographics or access history. Patency, reintervention, infection, and functional dialysis rates were examined.
  
  
  RESULTS
  Technical success was 99% in HB-PTFE and 98% in S-PTFE. The 30-day major adverse cardiovascular events were 2% in HB-PTFE and 3% in S-PTFE. Mean time to access was 5.1 ± 1.8 weeks for HB-PTFE and 6.9 ± 1.9 weeks for S-PTFE (P = .0001). Median follow-up was 23 months. The 2-year primary, assisted primary, and secondary patency rates were 20% ± 7% vs 18% ± 8% (P = .85), 35% ± 8% vs 28% ± 7% (P = .51), and 38% ± 6% vs 36% ± 7% (P = .83) for HB-PTFE vs S-PTFE, respectively. Both groups underwent a similar number of secondary interventions (2.1 and 1.9 interventions per person-year of follow-up for HB-PTFE vs S-PTFE respectively; P = .87). There were no significant differences in infection (11% vs 12%) or pseudoaneurysm formation (5% vs 6%) between HB-PTFE and S-PTFE groups. Functional dialysis durations were equivalent between HB-PTFE and S-PTFE groups.
  
  
  CONCLUSIONS
  HB-PTFE grafts offer no distinct advantage over S-PTFE grafts for hemodialysis and should not be considered a preferential conduit for AVG.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex. Electronic address: daviesm@uthscsa.edu.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.affiliation: Division of Vascular Diseases and Surgery, Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio.
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El-Sayed
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; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D006435:Renal Dialysis; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin