Should we use saphenous vein graft instead of synthetic graft for creation of secondary arteriovenous fistula in hemodialysis dependent end stage renal failure patients?

Abstract

Background: Patient groups with secondary arteriovenous fistula (AVF) management with saphenous vein (SV) graft and polytetrafluoroethylene (PTFE) graft for hemodialysis (HD) were reviewed in terms of patency and complication rate. Methods: Forty HD access procedures were performed in 40 consecutive patients between January 2006 and January 2010. All access procedures were planned on the basis of preoperative duplex ultrasonography (USG) scans of arm and forearm veins. Functional patency was defined as ability to cannulate for HD successfully for the patient. Primary and secondary cumulative functional patency of SV and PTFE grafts were determined with Kaplan Meier test; differences in patency rates were analyzed with Log Rank test and differences in revision rates including thrombolysis, thrombectomies and operative revisions were analyzed with the Z test and the Fisher's exact t-test. Results: Mean follow-up was 48 months (range 43-54 months). Risk factors were similar between the two groups. Saphenous vein graft had better patency rates. The HD access complications were higher in SV graft group, while infection and thrombosis were higher in PTFE group. Conclusion: Our data strongly support the necessity that SV graft should be considered initially, compared to PTFE graft, for the patient who is a candidate for an upper arm secondary AVF creation based on anatomical criteria.