Evaluation of Cold Stored Saphenous Vein Allografts for Hemodialysis Vascular Access: A Comprehensive Review
Abstract:
The utilization of cold stored saphenous vein allografts (CSVAs) for hemodialysis vascular access presents a promising alternative in cases where autogenous arteriovenous fistulas are unfeasible. This review critically examines the outcomes of CSVAs in comparison to traditional expanded polytetrafluoroethylene grafts, focusing on primary, primary assisted, and secondary patency rates, procedural complications, and incidences of re-intervention. The study, encompassing a retrospective analysis of 109 patients over a considerable follow-up period, underscores the comparable patency rates of CSVAs alongside a notably lower infection rate. Notably, 57.8% of patients exhibited stenosis, predominantly within the outflow, while thrombosis affected 49.5% of cases. The analysis provides valuable insights into the efficacy of CSVAs and highlights their clinical relevance in managing vascular access challenges, particularly in patients with a high risk of infection.
Introduction:
Surgical interventions for establishing hemodialysis vascular access pose a challenge in patients where traditional modes are unattainable. The emergence of CSVAs as a viable option warrants a comprehensive evaluation of their efficacy and safety profile. This article aims to critically assess the outcomes of CSVAs, shedding light on their clinical utility and the potential benefits they offer in hemodialysis management.
Key Findings:
Patency Rates: At 1 and 2 years, primary, primary assisted, and secondary patency rates for CSVAs were commendable, reflecting their viability as an alternative to conventional grafts.
Infection Rates: The study revealed a low incidence (4.6%) of access infections, with no associated fatalities, supporting the safety profile of CSVAs in hemodialysis patients.
Adverse Events: Considering competing risks such as mortality and renal transplantation, a fraction of patients experienced vascular access loss at 1 and 2 years, emphasizing the need for vigilant postoperative care.
Stenosis and Thrombosis: Stenosis primarily in the outflow (45.9%) and thrombotic events in almost half of the patients underscore the importance of surveillance and early intervention strategies in maintaining CSVAs.
Conclusion:
In conclusion, the evidence presented in this review underscores the viability of CSVAs as an effective option for hemodialysis vascular access, especially in patients with limited venous reserves and heightened infection risks. The findings advocate for a judicious assessment of infection risk factors before CSVAs placement, emphasizing the need to consider patient-specific variables for optimal outcomes.