目前,三种膨体聚四氟乙烯(ePTFE)假体类型最常用于需要长期血管通路进行血液透析的终末期肾病(ESKD)患者.然而,比较三种ePTFE移植物的研究有限。本研究比较了三种用于ESKD患者上肢动静脉移植(AVG)手术的ePTFE假体移植的临床疗效和术后并发症。纳入2016年1月至2019年9月入住我们中心的需要上肢AVG手术的ESKD患者。总的来说,282名完成2年随访的患者被纳入,并根据ePTFE移植类型分为以下三组:GPVG组采用PROPATEN®移植,带有直型GORE®ACUSEAL的GAVG组,以及带有VENAFLO®II的BVVG组。分析比较两组患者的通畅率和通路相关并发症发生率。术后对患者进行随访,数据收集于术后6,12,18和24个月.根据这些随访时间点,在GPVG组中,原发性通畅率为74.29%,65.71%,51.43%,42.86%;辅助原发通畅率为85.71%,74.29%,60.00%,和48.57%;二次通畅率为85.71%,80.00%,71.43%,和60.00%。在GAVG组中,原发性通畅率为73.03%,53.93%,59.42%,38.20%;辅助原发通畅率为83.15%,68.54%,59.55%,53.93%;二次通畅率为85.39%,77.53%,68.54%,62.92%,分别。在BVVG组中,原发性通畅率为67.24%,53.45%,41.38%,29.31%;辅助原发通畅率为84.48%,67.24%,55.17%,和44.83%;二次通畅率为86.21%,81.03%,68.97%,和60.34%,分别。三种移植物的通畅率差异无统计学意义。总的来说,GPVG中的18、4和12名患者,GAVG,和BVVG组,分别,经历血清肿。在三个移植物中,GORE®ACUSEAL吻合止血时间最短。三个移植物的首次插管时间为GPVG为16(±8.2),GAVG为4(±4.9),和BVVG在18(±12.7)天。GPVG组与其他两组的术后肿胀率差异无统计学意义。此外,关于术后血管通路狭窄和血栓形成,三种移植物类型之间没有发现统计学上的显着差异。缺血盗血综合征,假性动脉瘤,或感染。总之,术后原发性无统计学差异,辅助小学,在三组中观察到或继发性移植物通畅率。吻合止血时间较短,第一次插管时间,ACUSEAL®移植物比其对应物观察到血清肿的发生。PROPATEN®移植物术后上肢肿胀的发生率高于其他移植物。在其余并发症方面,三个移植物之间未观察到统计学上的显着差异。
Currently, three expanded polytetrafluoroethylene (ePTFE) prosthetic graft types are most commonly used for patients with end-stage kidney disease (ESKD) who require long-term vascular access for hemodialysis. However, studies comparing the three ePTFE grafts are limited. This study compared the clinical efficacy and postoperative complications of three ePTFE prosthetic graft types used for upper limb arteriovenous graft (AVG) surgery among patients with ESKD. Patients with ESKD requiring upper limb AVG surgery admitted to our center between January 2016 and September 2019 were enrolled. Overall, 282 patients who completed the 2-year follow-up were included and classified into the following three groups according to the ePTFE graft type: the GPVG group with the PROPATEN® graft, the GAVG group with the straight-type GORE® ACUSEAL, and the BVVG group with the VENAFLO® II. The patency rate and incidence of access-related complications were analyzed and compared between groups. The patients were followed up postoperatively, and data were collected at 6, 12, 18, and 24 months postoperatively. Respective to these follow-up time points, in the GPVG group, the primary patency rates were 74.29%, 65.71%, 51.43%, and 42.86%; the assisted primary patency rates were 85.71%, 74.29%, 60.00%, and 48.57%; and the secondary patency rates were 85.71%, 80.00%, 71.43%, and 60.00%. In the GAVG group, the primary patency rates were 73.03%, 53.93%, 59.42%, and 38.20%; the assisted primary patency rates were 83.15%, 68.54%, 59.55%, and 53.93%; and the secondary patency rates were 85.39%, 77.53%, 68.54%, and 62.92%, respectively. In the BVVG group, the primary patency rates were 67.24%, 53.45%, 41.38%, and 29.31%; the assisted primary patency rates were 84.48%, 67.24%, 55.17%, and 44.83%; and the secondary patency rates were 86.21%, 81.03%, 68.97%, and 60.34%, respectively. The differences in patency rates across the three grafts were not statistically significant. Overall, 18, 4, and 12 patients in the GPVG, GAVG, and BVVG groups, respectively, experienced seroma. Among the three grafts, GORE® ACUSEAL had the shortest anastomosis hemostatic time. The first cannulation times for the three grafts were GPVG at 16 (±8.2), GAVG at 4 (±4.9), and BVVG at 18 (±12.7) days. No significant difference was found in the postoperative swelling rate between the GPVG group and the other two groups. Furthermore, no statistically significant differences were found across the three graft types regarding postoperative vascular access stenosis and thrombosis, ischemic steal syndrome, pseudoaneurysm, or infection. In conclusion, no statistically significant differences in the postoperative primary, assisted primary, or secondary graft patency rates were observed among the three groups. A shorter anastomosis hemostatic time, first cannulation time, and seroma occurrence were observed with the ACUSEAL® graft than with its counterparts. The incidence of upper extremity swelling postoperatively was greater with the PROPATEN® graft than with the other grafts. No statistically significant differences were observed among the three grafts regarding the remaining complications.