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New biological solutions for hemodialysis access.
- Source :
-
The journal of vascular access [J Vasc Access] 2011 Jul-Sep; Vol. 12 (3), pp. 185-92. - Publication Year :
- 2011
-
Abstract
- Since Scribner described the first prosthetic chronic dialysis shunt in 1961, the surgical techniques and strategies to maintain vascular access have improved dramatically. Today, hundreds of thousands of patients worldwide are treated with some combination of native vein fistula, synthetic vascular graft, or synthetic semipermanent catheter. Despite significantly lower efficacy compared with autologous fistulae, the basic materials used for synthetic shunts and catheters have evolved surprisingly slowly. The disparity between efficacy rates and concomitant maintenance costs has driven a strong campaign to decrease the use of synthetic grafts and catheters in favor of native fistulae. Whether arguing the benefits of Fistula First or "Catheter Last," the fact that clinicians are in need of an alternative to expanded polytetrafluoroethylene (ePTFE) is irrefutable. The poor performance of synthetic materials has a significant economic impact as well. End-stage renal disease (ESRD) accounts for approximately 6% of Medicare's overall budget, despite a prevalence of about 0.17%. Of that, 15%-25% is spent on access maintenance, making hemodialysis access a critical priority for Medicare. This clinical and economic situation has spawned an aggressive effort to improve clinical care strategies to reduce overall cost and complications. While the bulk of this effort has historically focused on developing new synthetic biomaterials, more recently, investigators have developed a variety of cell-based strategies to create tissue-engineered vascular grafts. In this article, we review the evolution of the field of cardiovascular tissue engineering. We also present an update on the Lifelineā¢ vascular graft, an autologous, biological, and tissue-engineered vascular graft, which was the first tissue-engineered graft to be used clinically in dialysis patients.
- Subjects :
- Animals
Arteriovenous Shunt, Surgical adverse effects
Arteriovenous Shunt, Surgical history
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation history
History, 20th Century
History, 21st Century
Humans
Kidney Failure, Chronic history
Polytetrafluoroethylene
Prosthesis Design
Arteriovenous Shunt, Surgical instrumentation
Biocompatible Materials history
Bioprosthesis history
Blood Vessel Prosthesis history
Blood Vessel Prosthesis Implantation instrumentation
Kidney Failure, Chronic therapy
Renal Dialysis history
Tissue Engineering history
Subjects
Details
- Language :
- English
- ISSN :
- 1724-6032
- Volume :
- 12
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The journal of vascular access
- Publication Type :
- Academic Journal
- Accession number :
- 21404221
- Full Text :
- https://doi.org/10.5301/JVA.2011.6451