RESUMO
BACKGROUND: Application of a tissue-engineered vascular graft for small-diameter vascular reconstruction has been a long awaited and much anticipated advance for vascular surgery. We report results after a minimum of 6 months of follow-up for the first ten patients implanted with a completely biological and autologous tissue-engineered vascular graft. METHODS: Ten patients with end-stage renal disease who had been receiving haemodialysis through an access graft that had a high probability of failure, and had had at least one previous access failure, were enrolled from centres in Argentina and Poland between September, 2004, and April, 2007. Completely autologous tissue-engineered vascular grafts were grown in culture supplemented with bovine serum, implanted as arteriovenous shunts, and assessed for both mechanical stability during the safety phase (0-3 months) and effectiveness after haemodialysis was started. FINDINGS: Three grafts failed within the safety phase, which is consistent with failure rates expected for this high-risk patient population. One patient was withdrawn from the study because of severe gastrointestinal bleeding shortly before implantation, and another died of unrelated causes during the safety period with a patent graft. The remaining five patients had grafts functioning for haemodialysis 6-20 months after implantation, and a total of 68 patient-months of patency. In these five patients, only one intervention (surgical correction) was needed to maintain secondary patency. Overall, primary patency was maintained in seven (78%) of the remaining nine patients 1 month after implantation and five (60%) of the remaining eight patients 6 months after implantation. INTERPRETATION: Our proportion of primary patency in this high-risk cohort approaches Dialysis Outcomes Quality Initiative objectives (76% of patients 3 months after implantation) for arteriovenous fistulas, averaged across all patient populations.
Assuntos
Derivação Arteriovenosa Cirúrgica , Bioprótese , Prótese Vascular , Falência Renal Crônica/terapia , Diálise Renal , Engenharia Tecidual/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: Type 2 diabetes and essential hypertension are the most common causes of end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension. Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved from subgroups included in large-scale studies. SCOPE: The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, the primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.
Assuntos
Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Hipertensão/tratamento farmacológico , Pressão Sanguínea , Humanos , Hipertensão/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
ANTECEDENTES: La hipertensión y la diabetes son las causas mas comunes de insuficiencia renal terminal en Argentina, Sobre 887 transplantes de órganos efectuados en el año 2004, correspondieron 577 a transplantes renales, Sn poblaciones urbanas y rurales argentinas la hipertensión tiene una prevalencia mas alta en diabéticos, siendo el tipo mas frecuente la hipertensión sistólica. Los estudios sobre la evolución se utilizan para estimar los puntos finales altamente significativos desde la perspectiva clínica. Nuestros conocimientos actuales sobre los efectos del tratamiento de la hipertensión en la diabetes tipo 2 se fundan en los resultados obtenidos en estudios longitudinales randomizados. AMBITO: El presente trabajo, basado sobre una búsqueda en el periodo 19902005 de la literatura MEDLINE, revisa los estudios randomizados con el objetivo de determinar cuales son las mejores estrategias terapéuticas en esta asociación mórbida. La mayoría de los pacientes requieren dos a cuatro drogas antihipertensivas para enlentecer la progresión de daño de órganos nobles. La elección inicial de las drogas a utilizar debería fundarse sobre la presencia o no de complicaciones en órganos blanco. En aquellos pacientes sin evidencias de complicaciones, el objetivo primario es alcanzar niveles de PA < 130/80 mm Hg., mas allá de las diferencias que existen entre las distintas clases de fármacos, mientras que en aquellos con afectaciones de órgano blanco se requiere mantener la PA en < 120/75 mm Hg.
BACKGROUND: Type 2 diabetes and essential hypertension are the most common causes oi end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension, Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved fram subgroups included in large scale studies. SCOPE: The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, fue primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.