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Online ISSN 1827-1847
Gargiulo M. 1, Stella A. 1, Polverini I. 1, Lucchi L. 2, Buzzi M. 3, Bessone M. 1, Rumolo A. 1, Lonardi R. 1, Stipo L. 2, Mirelli M. 3, Conte R. 3
1 Department of Vascular Surgery University of Modena and Reggio Emilia, Modena, Italy
2 Department of Nephrology and Dialysis University of Modena and Reggio Emilia, Modena, Italy
3 Regional Cardiovascular tissue Bank of Emilia Romagna
Aim. The use of PTFE in the creation of prosthetic arteriovenous fistulas (PAVF) for hemodialysis is contraindicated in patients with hypotension, active infection or small vessel diameter. As an alternative to autogenous arteriovenous fistulas, these patients are often offered a permanent central venous catheter for hemodialysis access. This study reports the short-term clinical results (3 months) of the use of PAVF constructed from cryopreserved femoral arteries in patients in from PTFE is contraindicated.
Methods. Since April 2003, all patients in whom the use of PTFE is contraindicated (basal hypotension or hypotension during hemodialysis, active infection or at risk for infection, small vessel diameter) and who come to our unit for a PAVF have received an allograft constructed from cryopreserved femoral arteries provided by the Regional Cardiovascular Tissue Bank of Emilia-Romagna. According to our protocol, all patients received preoperative antibiotic therapy, which was continued for 2 weeks in patients with active infection, plus antiplatelet therapy associated with oral anticoagulant therapy; no patients received immunosuppressive therapy.
Results. From April to September 2003, 6 PAVF were constructed with a cryopreserved femoral artery in 6 patients (mean age, 67.8 years; diabetes in 50% of cases, hypotension in 50%; obesity in 33.3%); no patients were on a waiting list for renal transplantation. A loop construction was used in all 6 patients; in 5 the PAVF was created in the upper limb and in 1 in the lower limb. One patient died on postoperative day 4. Secondary patency and 30-day survival were 100% and 83.4%, respectively. Secondary patency at 3 months was 100%. None of the 5 cryopreserved femoral vein allografts developed problems associated with the use of the PAVF as a vascular access. In all patients, blood flow was adequate due to excellent depurative efficiency; no complications from infection were observed.
Conclusion. Cryopreserved femoral arterial allografts are a biological prosthesis suitable for the construction of a PAVF. Short-term results support the use of allografts in patients with infection, hypotension or small vessel diameter or in cases where PTFE is contraindicated. The use of a cryopreserved femoral artery allograft in the creation of vascular access for hemodialysis may significantly reduce the number of permanent central venous catheters for hemodialysis access.