Equivalent outcomes with standard and heparin-bonded expanded polytetrafluoroethylene grafts used as conduits for hemodialysis access.

Abstract

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). 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. 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. HB-PTFE grafts offer no distinct advantage over S-PTFE grafts for hemodialysis and should not be considered a preferential conduit for AVG.