Outcomes of cold stored saphenous vein allografts for haemodialysis vascular access

Selected in ESVS Journal by Perrine Darpy

In this two-center retrospective observational study, 109 patients with end-stage renal disease requiring hemodialysis were treated with cold-stored saphenous vein allografts (CSVAs) for vascular access. The study aimed to assess the patency of CSVAs over time and to evaluate associated complications. Findings showed that primary patency rates were comparable to those observed with prosthetic ePTFE fistulas, while infection rates appeared to be lower. These results support the potential of CSVAs as a viable alternative for selected patients needing vascular access.

References:

Authors: Rita Cherkaoui, Eric Picard, Pascal Branchereau, Charbel Saba, Lucie Derycke, Nicla Settembre, Serguei Malikov, Elsa Madeleine Faure

Reference: Eur J vasc endovascular surg (2024) 68, 397-404

DOI: DOI: 10.1016/j.ejvs.2024.04.042

Read the abstract

Objective:

To evaluate the current patency of cold-stored saphenous vein allografts for haemodialysis vascular access and to assess their outcomes by describing the incidence of each complication and specific factors affecting their patency over time.

Study:

Retrospective, two-center, observational.

Population:

109 patients with end stage renal failure requiring haemodialysis.

Endpoints:

Primary patency, assisted primary patency, secondary patency, and associated complications.

Outcomes of cold stored saphenous vein allografts for haemodialysis vascular access

Source: ESVS Journal

Outcomes and conclusion:

Primary patency comparable to an ePTFE AV fistula, with a reduction in the infection rate.

Comments:

Low rate of access loss but high rate of reintervention.
Primary patency rate:
- Gibson et al.: Patients with a history of AV fistula (AVF) have 2.56 times the risk of failure of an ePTFE AVF (history of AVF = 30%).
- This study: History of AVF = 88.1%.
- Cold-stored vein allograft (CSVA): Better primary patency in patients with a history of AVF.
Model includes factors such as death and kidney transplantation.
Anatomical variations considered.
Male gender found to be a protective factor.
Endothelial removal prior to cryopreserved vein implantation is theoretically non-immunologic.