Intermediate Outcome and Risk Factor Assessment of Bovine Vascular Heterografts used as AV-Fistulas for Hemodialysis Access

Abstract

Objectives. This observational study was set up to prospectively follow all bovine heterograft (ProCol®) fistulas implanted for hemodialysis access between 1998 and 2002.Methods. ProCol® was implanted if autogenous vein was not available or if patients presented with a history of failed, infected or otherwise complicated ePTFE grafts and/or on immunosuppressive therapy. Fistula patency was the primary outcome; secondary outcomes were clinical events and the rate of access revisions.Results. Sixty-two ProCol® grafts were implanted in 56 patients. The mean primary (PP) and secondary patency (SP) was 334 (SEM 57) and 528 (SEM 59) days, respectively. Coronary heart disease was associated with a significantly better SP (OR 0.2, 95% CI 0.1–0.9) whilst diabetes mellitus was associated with a significantly worse SP (OR 0.2, 95% CI 0.1–0.9). Reinterventions were performed at a mean rate of 1.23 (SEM 0.17) per fistula. The relative risk of access revision was significantly higher in patients with diabetes mellitus (OR 9.2, 95% CI 2.3–37.2).Conclusions. ProCol® grafts, used for AV-fistulas, demonstrate acceptable patency rates in high-risk haemodialysis patients. Diabetes mellitus jeopardizes the patency of these fistulas and is associated with a high revision rate.