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• W4254972011 abstract "The study by Todd McAllister and colleagues1McAllister TN Maruszewski M Garrido SA et al.Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study.Lancet. 2009; 373: 1440-1446Summary Full Text Full Text PDF PubMed Scopus (404) Google Scholar is valuable in the tissue-engineering field. However, we have some concerns.First, one of the patients (patient 8) developed acute aneurysmal changes; this phenomenon is never seen with expanded polytetrafluoroethylene (ePTFE) arteriovenous grafts.Second, the definition of access complications used by McAllister and colleagues is not clear, particularly with regard to venous hypertension and steal syndrome (ie, vascular insufficiency resulting from arteriovenous fistula). These two complications manifest in a wide range of ways from mild hand swelling and ischaemia to severe symptoms needing immediate intervention.2Moini M Williams GM Pourabbasi MS et al.Side-to-side arteriovenous fistula at the elbow with perforating vein ligation.J Vasc Surg. 2008; 47: 1274-1278Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar It is difficult to accept that these high-risk patients, some of whom had a history of repeated central vein catheterisation, were completely symptom-free and did not experience hand swelling and discomfort. The development of steal syndrome is more likely with arteriovenous grafts than arteriovenous fistula.3Moini M Rasouli MR Ligation of the perforating vein for treatment of steal syndrome in arteriovenous grafts: a hypothesis.Kidney Int. 2008; 74: 826Crossref PubMed Scopus (2) Google Scholar In patient 5, postoperative flow through the graft was higher than the normal range, making the patient susceptible to the development of distal ischaemia. It is therefore possible that the patient experienced a mild degree of steal syndrome.Third, graft puncture was not started before 4 months, so readers cannot judge the exact time required for graft maturation.Despite these limitations, however, the lower infection rate is a great advantage over ePTFE grafts.We declare that we have no conflicts of interest. The study by Todd McAllister and colleagues1McAllister TN Maruszewski M Garrido SA et al.Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study.Lancet. 2009; 373: 1440-1446Summary Full Text Full Text PDF PubMed Scopus (404) Google Scholar is valuable in the tissue-engineering field. However, we have some concerns. First, one of the patients (patient 8) developed acute aneurysmal changes; this phenomenon is never seen with expanded polytetrafluoroethylene (ePTFE) arteriovenous grafts. Second, the definition of access complications used by McAllister and colleagues is not clear, particularly with regard to venous hypertension and steal syndrome (ie, vascular insufficiency resulting from arteriovenous fistula). These two complications manifest in a wide range of ways from mild hand swelling and ischaemia to severe symptoms needing immediate intervention.2Moini M Williams GM Pourabbasi MS et al.Side-to-side arteriovenous fistula at the elbow with perforating vein ligation.J Vasc Surg. 2008; 47: 1274-1278Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar It is difficult to accept that these high-risk patients, some of whom had a history of repeated central vein catheterisation, were completely symptom-free and did not experience hand swelling and discomfort. The development of steal syndrome is more likely with arteriovenous grafts than arteriovenous fistula.3Moini M Rasouli MR Ligation of the perforating vein for treatment of steal syndrome in arteriovenous grafts: a hypothesis.Kidney Int. 2008; 74: 826Crossref PubMed Scopus (2) Google Scholar In patient 5, postoperative flow through the graft was higher than the normal range, making the patient susceptible to the development of distal ischaemia. It is therefore possible that the patient experienced a mild degree of steal syndrome. Third, graft puncture was not started before 4 months, so readers cannot judge the exact time required for graft maturation. Despite these limitations, however, the lower infection rate is a great advantage over ePTFE grafts. We declare that we have no conflicts of interest. Haemodialysis access via tissue-engineered vascular graft – Authors' replyOur report of a completely autologous tissue-engineered vascular graft triggered a range of comments from the readership. Although these letters recognise the importance of these first human studies, several comments focus on the issue of aneurysm formation. Indeed, aneurysm formation has been the fundamental challenge for tissue-based vascular prostheses, dating back to the Sparks-mandril graft in the 1960s.1 Interestingly, however, this historical association with dilatation has typically been a long-term response. Full-Text PDF" @default.
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• W4254972011 title "Haemodialysis access via tissue-engineered vascular graft" @default.
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• W4254972011 doi "https://doi.org/10.1016/s0140-6736(09)61327-1" @default.
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