Use of the Vectra Polyetherurethaneurea Graft for Dialysis Access in HIV-Positive Patients With End-Stage Renal Disease

Abstract

The primary objective of this study was to establish the safety, efficacy, infection rate, and patency of the Vectra graft (polyetherurethaneurea) for dialysis access in patients diagnosed with human immunodeficiency virus (HIV) and end-stage renal disease. The Vectra graft has a unique self-sealing property; therefore we hypothesize that these patients will have fewer infections. A Vectra graft was implanted in 30 consecutive HIV-positive patients without sufficient veins for an autologous fistula. These surgeries were carried out over a 2.5-year period. Primary graft patency was 42% at 12 months and 3 (10%) of the grafts developed infection. This rate of graft infection was less (10% vs 45%) than both our prior experience and published reports using polytetrafluorothene bridge grafts. The unique self-sealing property of the Vectra graft minimizes the development of perigraft hematoma with repetitive needle cannulation and in the immunosuppressed HIV-positive patient, may account for the observed decrease in dialysis access infection.

Keywords

end-stage renal disease HIV Vectra vascular access patency infection thrombosis

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References

Ahuja TS , O'Brien WA Special issues in the management of patients with ESRD and HIV infection . Am J Kidney Dis. 2003;41:279-291.

Mokrzycki MH , Schroppel B. , von Gersdorff G. , Rush S. , Zdunek MP , Feingold R. Tunneled-cuffed catheter associated infections in hemodialysis patients who are seropositive for the human immunodeficiency virus. J Am Soc Nephrol. 2000;11:2122-2127.

Rao Tks. Human immunodeficiency virus infection in end-stage renal disease patients. Semin Dial. 2003;16: 233-244.

Mailloux LU , Bellucci AG , Wiles BM , et al. Mortality in dialysis patients: analysis of causes of death . Am J Kidney Dis. 1991;18:3326-3335.

Nassar GM , Ayus JC Infectious complications of the hemodialysis access. Kidney Int. 2001;60:1-13.

Schild AF , Simon S. , Prieto J. , Raines J.

Single-center review of infections associated with 1574 consecutive vascular access procedures. Vasc Endovasc

Surg. 2003 ;37:27-31.

Brock JS , Sussman M. , Wamsley M. , Mintzer R. , Baumann FG , Riles TS The influence of human immunodeficiency virus infection and intravenous drug abuse on complications of hemodialysis access surgery. J Vasc Surg. 1992;16:904-910.

Curi MA , Pappas PJ , Silva MB , et al. Hemodialysis access: influence of the human immunodeficiency virus on patency and infection rates. J Vasc Surg. 1999;29:608-616.

Anderson JE , Chang AS , Anstadt MP Polytetrafluoroethylene hemo-access site infections. ASAIO J. 2000;46: S18-S21.

10.

Glickman MH , Stokes GK , Ross JR , et al. Multicenter evaluation of a polytetrafluoroethylene vascular access graft as compared with the expanded polytetrafluoroethylene vascular access graft in hemodialysis applications. J Vasc Surg. 2001;34:465-473.