Ag. Hakaim et Te. Scott, DURABILITY OF EARLY PROSTHETIC DIALYSIS GRAFT CANNULATION - RESULTS OF A PROSPECTIVE, NONRANDOMIZED CLINICAL-TRIAL, Journal of vascular surgery, 25(6), 1997, pp. 1002-1006
Purpose: Initiation of hemodialysis frequently requires temporary cent
ral venous catheterization, which leads to subsequent venous stenosis
in 50% of patients. These lesions severely limit upper extremity dialy
sis fistula creation. The present study was undertaken to determine wh
ether early cannulation (EC) allowed omission of temporary venous cath
eterization without affecting perioperative morbidity and long-term gr
aft patency. Methods: Seventy-nine prosthetic grafts for hemodialysis
were placed in 76 patients over a 40-month period. Patients who requir
ed hemodialysis between 24 and 72 hours after surgery were assigned to
EC. The remaining grafts underwent late cannulation (LC) after postop
erative day 14. All grafts were constructed with a 6 mm stretch-expand
ed polytetrafluoroethylene conduit in the brachial artery-to-axillary
vein position. Statistical analysis of cumulative primary patency esti
mates and patient survival data were determined by Kaplan-Meier analys
is and log-rank test, patient variables were compared using chi(2) and
Fisher's exact test, and multivariate analysis was performed using Co
x's proportional hazard model. Results: Forty-eight patients underwent
EC and 31 underwent LC. There were no significant differences regardi
ng age (mean, 61.5 years), history of diabetes, congestive heart failu
re, hematocrit level (mean, 30%), or presence of peripheral vascular d
isease. Thrombosis occurred before cannulation in one of 48 ECs (2.0%)
and one of 31 LCs (3.2%). There were no episodes of cannulation hemor
rhage or wound infection in either group. Cumulative primary patency e
stimates for EC were 0.89, 0.82, and 0.70 at 3, 6, and 12 months, resp
ectively. These were not significantly different from tile LC estimate
s of 0.86, 0.78 and 0.74 at 3, 6, and 12 months, respectively. Overall
, patients who had a history of peripheral vascular disease had a sign
ificantly decreased 12-month patency late (60% vs 74%; p = 0.05). Cent
ral venous catheters were emitted in 47 of 48 EC patients. Conclusion:
EC of prosthetic dialysis grafts does not increase perioperative morb
idity rates or decrease 12-month cumulative primary patency rates.