即穿型人造血管与膨化聚四氟乙烯人造血管在建立血管通路中的应用

Application of self-sealing vascular graft and expanded polytetrafluoroethylene vascular graft in establishment of vascular access

目的比较即穿型人造血管与膨化聚四氟乙烯人造血管在维持性血液透析患者建立动静脉内瘘中的应用效果,为临床选择人造血管提供参考。方法选择自2016年10月1日至2018年5月31日于北京市海淀医院住院行人造血管内瘘手术的终末期肾病患者,按选用人造血管类型分为即穿型人造血管组(Acuseal组)及膨化聚四氟乙烯组(ePTFE组),所有患者随访至通路废弃、患者死亡、失访或研究终止日期(2019年5月31日)。比较两组患者内瘘首次穿刺时间及通路相关并发症发生情况,采用Kaplan-Meier生存曲线比较两组患者原发通畅率、累积通畅率。结果共入组108例患者,其中Acuseal组55例,ePTFE组53例,两组患者在年龄、性别、原发病、透析龄、用药情况、相关化验指标及吻合血管内径方面差异无统计学意义。与ePTFE组比,Acuseal组平均穿刺时间短,分别为(67.1+36.3)d vs(3.2+2.1)d(P<0.01);Acuseal组与ePTFE组6个月、12个月原发通畅率分别为58.2%vs 71.7%(P=0.14),32.7%vs 50.9%(P=0.06);原发辅助通畅率分别为67.3%vs 84.9%(P=0.06),54.5%vs 73.6%(P=0.07);累积通畅率分别为96.3%vs 92.6%(P=0.23),85.5%vs 87.0%(P=0.66),差异无统计学意义。Acuseal组、ePTFE组感染发生率分别为10.9%vs 3.7%(P=0.29),通路相关缺血发生率分别为3.6%vs 5.7%(P=0.16);假性动脉瘤发生率分别为0%vs 5.7%(P=0.07);差异无统计学意义。Acuseal组发现4例人造血管分层现象。结论同ePTFE相比,即穿型人造血管Acuseal允许早期穿刺,且不影响长期通畅率,不增加并发症发生风险,有临床应用价值。

Objective To compare application effects of self-sealing vascular graft(Acuseal)and expanded polytetrafluoroethylene(ePTFE)vascular grafts in establishment of arteriovenous fistula in maintenance hemodialysis patients,so as to provide reference for clinical selection of artificial vascular grafts.Methods A total of 108 patients,who were hospitalized to undergo vascular graft fistula surgery in Beijing Haidian Hospital from 1 October 2016 to 31 May 2018,were selected and divided into Acuseal group and ePTFE group based on types of vascular grafts.All patients were followed up to depletion of vascular accesses,patient death,lost of follow-up or the termination date of the study.First fistula puncture time and access-associated complications were compared in the patients between the two groups.Through Kaplan-Meier survival curve,primary patency and accumulative patency.Results A total of 108 patients were enrolled,with 55 ones in the Acuseal group and 53 ones in the ePTFE group.There is no difference of statistical significance between the patients in the two groups in age,sex,primary disease,dialysis age,drug use,related laboratory test indexes and internal diameter of anastomosed vessels.Compared to the ePTFE group,the mean puncture time for the Acuseal group was shorter,with(67.1+36.3)d vs(3.2+2.1)d respectively for the two groups(P<0.01).The 6-month/12-month primary patency values for the Acuseal and ePTFE groups were 58.2%vs 71.7%(P=0.14),and 32.7%vs 50.9%(P=0.06);the primary accessory patency values,67.3%vs 84.9%(P=0.06)and 54.5%vs 73.6%(P=0.07);the accumulative patency values,96.3%vs 92.6%(P=0.23),and 85.5%vs 87.0%(P=0.66),with no statistically significant difference.The infection incidences for the Acuseal and ePTFE groups were 10.9%vs 3.7%respectively;the access-associated ischemia incidences,3.6 vs 0 respectively;the pseudoaneurysm incidences,0 vs 5.7%(P=0.07)respectively,with no statistically significant difference.In the Acuseal group 4 cases of lamination of vascular graft were observed.Conclusions Compared to the ePTFE vascular graft,the self-sealing vascular graft(Acuseal)allows for early access without compromising long-term patency or increasing the risk of complications,and so has value for clinical application.