Background
Autogenous arteriovenous fistula (AVF) remains the standard of hemodialysis (HD) access;
however, it cannot be reasonably obtained in all patients. For patients with contraindications
to AVFs, prosthetic arteriovenous graft (AVG) remains an alternative. AVGs are plagued
by high failure rates; however, there is a paucity of literature examining this. This
study aims to examine a single-center review of outcomes of forearm loop AVGs in patients
requiring HD access.
Methods
A single institution, retrospective chart review was completed from 2012 to 2019,
including demographics, end-stage renal disease etiology, brachial vessel diameters,
and comorbidities. Logistic regression and Cox proportional hazard models were evaluated.
Outcomes were defined as primary patency (time elapsed from graft creation until it
was utilized as the patient’s primary access), primary-assisted patency (time from
primary access to intervention to maintain patency), and functional patency (time
from graft placement until graft failure). Additionally, multinomial regression models
were used to evaluate associations with categorical number of required interventions.
Results
Ninety-eight patients [mean age 61.8 (13.9) years, 42.9% female] were identified as
having brachial artery to brachial vein AVG creation during the study period, of which
75% achieved primary patency. Primary-assisted patency was 0.36 [standard error (SE)
0.07] at 6 months and 0.12 (SE 0.05) at 1 year. Functional patency was 0.75 (SE 0.07)
at 6 months and 0.43 (SE 0.09) at 1 year. No association between preoperative vessel
diameters and primary-assisted or functional patency was observed. Interestingly,
there was a significant negative association between previous ipsilateral access and
achievement of primary patency with a 60% decrease in odds of achieving primary patency
in patients with previous ipsilateral access [odds ratio 0.4, 95% confidence interval
(CI) 0.1–0.9, P = 0.03]. There was also noted to be a significant association between the presence
of an ipsilateral catheter and increased risk of subsequent abandonment of the AVG
(hazard ratio 2.6, 95% CI 1.1–5.8, P = 0.02).
Conclusions
Prosthetic forearm loop AVGs remain hindered in their utility as they show high rates
of graft failure within a year of creation. A significant patient-specific factor
leading to this was not clearly demonstrated. As guidelines change regarding the nature
of dialysis access for patients on HD, these results draw into question the utility
of prosthetic forearm loop grafts in patients requiring long-term HD access.
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Article Info
Publication History
Published online: July 08, 2022
Accepted:
June 23,
2022
Received:
May 10,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors have no financial disclosures to make.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
