Results of the use of venous homographs for the formation of permanent vascular access for hemodialysis

Background: Chronic kidney disease is widespread (10-13% of the world’s population), irreversible, progressive, and associated with an increased risk of cardiovascular disease. Every year, there are 10-12% more patients with end-stage renal failure. They are shown renal replacement therapy by conducting programmed hemodialysis through permanent vascular access. Aims: to evaluate the results of the use of freshly prepared venous homographs in the formation of permanent vascular access in patients with stage V chronic kidney disease, in comparison with the use of synthetic prostheses. Materials and methods: A retrospective study included 40 patients with stage V CKD who underwent PSA formation with a synthetic prosthesis (SSP) and venous femoral vein homograft. Depending on the material used, 2 groups were formed: group 1 – SSP was used (n = 22), group 2 – femoral vein homograph was used (n = 18). Homograft was used in patients after SSP thrombosis and/or with paraprosthetic access infection. In patients after the formation of PSD (synthetic conduit and venous homograph) in the postoperative period, the following were assessed: primary patency after 1.5 months, 3 months, 6 months, 9 months and 12 months after the formation of access, complications during puncture and needle extraction, and the level of recirculation 12 months after the formation of access. The frequency of formation of aneurysms of biological conduits has been studied. The total follow-up period for patients after the formation of PSD (synthetic conduit and venous homograph) was 1 year. Results: The patency of permanent vascular access after 12 months in the first group was 86%, the patency of permanent vascular access after 12 months in the second group was 94%. There was no statistically significant difference in the patency of permanent vascular access between the groups (P = 0.82). During puncture and needle extraction, no bleeding was observed from the homograph during hemodialysis during the follow-up period. There was no significant level of recycling in both groups by the end of the study (14±5.1% in the group of synthetic vascular prostheses (SSP) and 16±4.2% in the group of homographs). No aneurysmal transformation of homographs was detected during the 12 months of follow-up. Conclusions: The formation of PSD by venous homograft can be considered an acceptable alternative to synthetic conduit.