Lack of evidence for use of heparin-bonded grafts in access surgery: A meta-analysis

• Published in: Seminars in vascular surgery 2016-12, Vol.29 (4), p.192-197
• Main Authors: Lazarides, MK, MD, FEBVS, Argyriou, C., MD, Antoniou, GA, MD, FEBVS, Georgakarakos, E., MD, Georgiadis, GS, MD
• Format: Article
• Language: English
• Subjects: Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Arteriovenous Shunt, Surgical - adverse effects; Arteriovenous Shunt, Surgical - instrumentation; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Chi-Square Distribution; Coated Materials, Biocompatible; Evidence-Based Medicine; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - therapy; Heparin - administration & dosage; Heparin - adverse effects; Humans; Odds Ratio; Renal Dialysis; Renal Insufficiency, Chronic - therapy; Risk Factors; Surgery; Time Factors; Treatment Outcome; Vascular Patency
• ISSN: 0895-7967; 1558-4518
• DOI: 10.1053/j.semvascsurg.2016.08.003

Abstract The aim of this study was to evaluate the efficacy of heparin-bonded vascular grafts to offer improved outcomes compared to standard prosthetic grafts in access surgery. A systematic review and meta-analysis was performed and 8 studies (7 observational studies and one randomized controlled trial) were included. The pooled 6-month and 1-year primary patency was not significantly different between heparin-bonded arterio-venous (AV) grafts and standard prosthetic AV grafts in seven studies reporting on 1209 access procedures. The assisted primary patency and secondary patency at 1-year was not significantly different either. In conclusion heparin-bonded AV grafts offer no distinct advantage over standard prosthetic AV grafts and their preferential use in access surgery cannot be recommended based on the available evidence. The heparin-bonded vascular grafts introduced for hemodialysis access in 2006, contain heparin molecules covalently bonded to the graft luminal surface by a proprietary endpoint attachment mechanism (Carmeda BioActive Surface, Carmeda AB, Stockholm, Sweden), which anchors the heparin molecule to the graft surface while preserving the intrinsic bioactive property of heparin. This covalent attachment of heparin provides a stable non leaching heparin surface of the graft, which has the theoretical advantage to prevent clotting and to increase patency [1] . Improved patency was observed in such heparin-bonded grafts (HB-PTFE) compared to standard synthetic grafts (S-PTFE) in a canine model,2 however, controversy remains as to whether they offer improved patency rates compared to S-PTFE AV (arteriovenous) grafts and the results of existing comparative studies are contradictory [1]. The aim of this systematic review and meta-analysis was to summarize the currently available evidence and investigate potential benefits of HB-PTFE AV grafts compared with S-PTFE AV grafts.