Are Heparin-Bonded Arteriovenous Grafts Better than the Standard-Wall?

Objectives: Arteriovenous fistulae (AVF) are the preferred vascular access for hemodialysis patients. For patients without suitable veins, arteriovenous graft (AVG) placement is required. Heparin-bonded polytetrafluoroethylene (PTFE) grafts have been shown to have improved patency rates compared to standard-wall controls. We analyzed the outcomes of upper extremity heparin-bonded PTFE grafts compared to standard-wall PTFE and brachiocephalic AVF.
Methods: A retrospective analysis of patients who underwent a vascular access procedure from 1/2006 to 12/2008 was performed. Complication rates, primary, primary-assisted, secondary, and functional access patency rates were compared using logistic regression and accounting for correlation among observation coming from the same subjects.
Results: We performed 210 dialysis access procedures including brachiocephalic AVF (n=67) and tapered brachial-axillary AVG (n=66). All grafts were tapered PTFE (heparin-bonded n=33, standard-wall n=33). 1-year primary, primary-assisted, and secondary patency rates of AVF vs. AVG were 80% vs. 72.6% (OR 1.13, 95% CI 0.37-3.46), 93.8% vs. 87.1% (OR 0.92, 95% CI 0.22-3.9), and 89.2% vs. 74.2% (OR2.3, 95% CI 0.7-7.4). Overall 1-year functional access patency of brachiocephalic AVF was 83.3% compared with 58.2% in AVG (OR 1.33, 95% CI 0.41-4.32). 1-year thrombosis rates between standard-wall and heparin-bonded PTFE were 39.4% and 27.6% (OR 1.32, 95% CI 0.29-6). 30-day postoperative complication rates of AVF vs. AVG were 4.4% and 16.7%, respectively (OR 0.34, 95% CI 0.06-1.91). Type of AVG, age, body-mass index, dyslipidemia, hypertension, diabetes, or history of previous access made no statistical difference in complications or patency rates.
Conclusions: Native AVF is the preferred long-term access for hemodialysis. There is no significant difference in the patency and complication rates of heparin-bonded PTFE compared to standard-wall PTFE. Co-morbid conditions did not affect the patency or complication rates of brachiocephalic AVF or AVG in this analysis. Larger, randomized trials are needed to validate the results of this study.