J Korean Med Sci.  2016 Aug;31(8):1266-1272. 10.3346/jkms.2016.31.8.1266.

Clinical Outcomes of Cryopreserved Arterial Allograft Used as a Vascular Conduit for Hemodialysis

• Ha TY
• Kim YH
• Chang JW
• Park Y
• Han Y
• Kwon H
• Kwon TW
• Han DJ
• Cho YP
• Lee SG

• KMID: 2373755
• DOI: http://doi.org/10.3346/jkms.2016.31.8.1266

Abstract

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.

Keyword

Allografts; Cryopreservation; Renal Insufficiency; Vascular Access Devices

MeSH Terms

Adult
Arteries/*transplantation
Blood Vessel Prosthesis
Cohort Studies
*Cryopreservation
Female
Hematoma/diagnosis
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/therapy
Male
Middle Aged
Renal Dialysis
Transplantation, Homologous
Vascular Access Devices
Veins/pathology

Figure

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  Fig. 1 Flow chart of patient inclusion. AVF, arteriovenous fistula; AVG, arteriovenous graft; HD, hemodialysis; pre-HD, access placement before initiation of hemodialysis; on HD, access placement after initiation of hemodialysis.

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  Fig. 2 Pathologic findings of the allograft and matured vein. (A) Histologic evaluation of the allograft from a malfunctioned upper arm vascular access shows fibrosis and hyalinization of media and fibrous intimal thickening (H & E, × 100). (B) Elastic staining of the allograft reveals fragmentation of internal elastic lamella, widening of interlamellar spaces and extensive loss of elastic framework in media (Elastic van Gieson, × 100). (C) Histologic evaluation of the matured vein from a malfunctioned autogenous arteriovenous fistula shows extensive fibrous intimal thickening with myxoid degeneration and luminal occlusion (H & E, × 40).

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  Fig. 3 Kaplan-Meier estimates of primary and cumulative access survivals. (A) Primary (unassisted) and (B) cumulative (assisted) access survival of upper arm vascular accesses using cryopreserved iliac arterial allografts and prosthetic grafts.

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