Better patency, lower rate of infection and steal syndrome in HD-vascular access grafts made using biological or semi-biological materials

Better patency, lower rate of infection and of steal syndrome in HD-vascular access grafts made using biological /semi-biological materials. Berardinelli ,Beretta, Raiteri. Objectives: the patency, as well as the rate of Dialysis Access Related Infection (DARI) and Steal Syndrome (SS) phenomena are investigated in vascular access grafts (VAGs) for hemodialysis, constructed using biological and semi- biological vascular substitutes Patients and methods: A sample was created for this study of DARI by selecting a continuative series of 758 new VAGs constructed in 543 patients at our Institution between January 1990 and December 2006, employing biological materials (Group I:593 VAGs), that are homologous saphenous vein (351 VAGs ), mesenteric vein (145 VAGs ), new bovine ureter (97 VAGs), semi-biological ovine collagen (Group II), consisting of 148 VAGs and synthetic grafts (17 VAGs) as vascular substitute. The patencies, calculated by Kaplan Meier method, the infection rate and the incidence of steal syndrome, expressed as the number of re-operations per 1000 graft function months (GFMs), were investigated according to the nature of the vascular substitute, that is biological or semi-biological, being the synthetic material group too small for any considerations. Results: The secondary patencies were 76%, 61% and 53% at 1,3 and 5 years for the biological AVG group, whereas the semi-biological group evidenced patencies of 75%, 60%, and 55% at the same time points. 30 DARI infections (1.3 episodes per 1000 GFMs) and 2 steal syndromes (0.09 per 1000 GFMs were identified as cause of re-operation in patients who received a biological vascular access graft; the group of semi-biological VAGs were submitted to 9 re-operations because of infection(1.8 per 1000 GFMs) and one re-operation because of steal syndrome (0.2 episodes per 1000 GFMs). Conclusions Biological and semi- biological materials offer some advantages versus synthetic materials in VAG construction, showing better primary and secondary patencies, lower incidence of infection and steal syndrome; more satisfactory results of access redo-surgery can also be observed, even in difficult patients.