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Comparative Study
. 2016 Jul;64(1):155-62.
doi: 10.1016/j.jvs.2016.02.033. Epub 2016 Apr 8.

Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use

James C Harms  1 , Sunil Rangarajan  1 , Carlton J Young  2 , Jill Barker-Finkel  3 , Michael Allon  4
Affiliations
Comparative Study

Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use

James C Harms et al. J Vasc Surg. 2016 Jul.

Abstract

Objective: Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts (AVGs) because of longer secondary patency after successful cannulation for dialysis. We evaluated whether access interventions before successful cannulation affect the relative longevity of AVFs and AVGs after successful use.

Methods: This retrospective study of a prospective database identified patients who initiated dialysis with a catheter and subsequently had a permanent access (289 AVFs and 310 AVGs) placed between January 1, 2006, and December 31, 2011, and were successfully cannulated for dialysis at a large medical center. Patients were monitored until June 30, 2014, and we evaluated the clinical outcomes (secondary patency and frequency of interventions) of the vascular accesses.

Results: An intervention before successful cannulation was required more frequently with AVFs than with AVGs (50.5% vs 17.7%; odds ratio, 4.74; 95% confidence interval [CI], 3.26-6.86; P < .0001). Compared with AVFs that matured without interventions, those that required intervention had shorter secondary patency after successful cannulation (hazard ratio, 1.84; 95% CI, 1.30-2.60; P < .0001) and required more interventions per year after successful use (rate ratio [RR], 1.81; 95% CI, 1.49-2.20; P < .0001). Similarly, AVGs that required intervention before successful cannulation had shorter secondary patency than those without prior intervention (odds ratio, 1.98; 95% CI, 1.52-4.02; P < .0001) and required more interventions per year after successful use (RR, 1.49; 95% CI, 1.27-1.74; P < .0001). AVFs requiring intervention before maturation had inferior secondary patency compared with AVGs that were cannulated without prior intervention (hazard ratio, 1.45; 95% CI, 1.08-2.01; P = .01), but required fewer annual interventions after successful use (RR, 0.57; 95% CI, 0.49-0.66; P < .0001).

Conclusions: The patency advantage of AVFs over AVGs is no longer evident in patients requiring an AVF intervention before successful cannulation, but the AVFs require fewer interventions after successful use.

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Figures

Figure 1
Figure 1. Cumulative access patency of AVFs that matured with or without prior interventions and AVGs that did or did not require intervention prior to successful cannulation
Access patency was shorter for AVF with prior intervention than AVF without interventions (P < .0001). Access patency was shorter for AVG with prior interventions than AVG without intervention (P < .0001). Access patency was similar for AVF and AVG without prior interventions (P =.16). Cumulative access patency was worse for AVF with prior interventions than for AVG without prior interventions (P = .01).
Fig 2
Fig 2. Causes of AVF and AVG failure
Inf, infection; Pseudo-an, pseudoaneurysm; CVC, central vein stenosis. * P < .01.
Fig 3
Fig 3. Annual frequency of AVF and AVG interventions after successful access use
Values are 95% CI. P < .0001 for AVF with prior intervention vs AVF without intervention. P < .0001 for AVG with prior intervention vs AVG without intervention. P < .0001 for AVF without intervention vs AVG without intervention. P < .0001 for AVF with intervention vs AVG without intervention.
See this image and copyright information in PMC

References

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