Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 3;22(5):1064-1071.
doi: 10.7150/ijms.106651. eCollection 2025.

Routine Clinic Surveillance on Arteriovenous Graft Patency in Hemodialysis Patients with Previous Access Complications

Cheng-Chieh Yen  1 , Hung-Pin Tu  2 , Tzu-Chen Lin  3   4 , Kuan-Ying Li  5 , Szu-Chia Chen  6   7   8
Affiliations

Routine Clinic Surveillance on Arteriovenous Graft Patency in Hemodialysis Patients with Previous Access Complications

Cheng-Chieh Yen et al. Int J Med Sci. .

Abstract

Background: Arteriovenous grafts (AVGs) are an alternative for hemodialysis (HD) access in patients with inadequate vasculature or advanced age. The effect of routine surveillance for AVG maintenance remains unclear. This study assesses the clinical and economic outcomes of routine surveillance at a collaborative clinic in patients with previous access complications. Methods: We recruited HD patients from the initiation of the clinic in 2020, and divided them into two groups: those receiving routine surveillance and those without. Primary outcomes included AVG interventions (e.g., arteriovenous access [AVA] reconstruction, graft-anastomosis stenting, percutaneous transluminal angioplasty [PTA]). Other outcomes included AVG secondary patency and costs associated with the interventions. Results: Twenty-two patients with routine surveillance and 65 without were recruited. There was no significant difference in AVA reconstruction rate between the surveillance and non-surveillance groups (0.46 vs. 0.5 per 100 patient-months, p = 0.99), however, rates of graft-anastomosis stenting (0.66 vs. 0.2 per 100 patient-months, p = 0.02) and PTA (30.19 vs. 14.17 per 100 patient-months, p < 0.01) were significantly higher in the surveillance group. No significant difference was observed in secondary patency (hazard ratio: 0.83, p = 0.79). The total costs of AVG interventions were more than double in the surveillance group (110672 New Taiwan Dollar [NTD] vs. 51874 NTD, p < 0.01). Conclusions: Routine clinic surveillance in HD patients with AVGs and previous access complications resulted in significantly higher rates of graft-anastomosis stenting, PTA, and associated costs, without significant differences in AVA reconstruction rates or secondary patency. These results highlight the need for further assessment of the cost-effectiveness of routine AVG monitoring.

Keywords: arteriovenous graft; outcomes; routine surveillance.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow diagram of the recruitment, allocation, and follow-up. AVA: arteriovenous access; AVF: arteriovenous fistula; HD: hemodialysis; PTA: percutaneous transluminal angioplasty.
Figure 2
Figure 2
Secondary patency of AVG in patients with and without routine clinic surveillance. AVA: arteriovenous access; AVG: arteriovenous graft; HR: hazard ratio.
See this image and copyright information in PMC

References

    1. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM. et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. American journal of nephrology. 2021;52(2):98–107. - PMC - PubMed
    1. Murakami M, Fujii N, Kanda E, Kikuchi K, Wada A, Hamano T. et al. Association of Four Types of Vascular Access Including Arterial Superficialization with Mortality in Maintenance Hemodialysis Patients: A Nationwide Cohort Study in Japan. American journal of nephrology. 2023;54(3-4):83–94. - PMC - PubMed
    1. Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K. et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2020;75(4 Suppl 2):S1–s164. - PubMed
    1. Jadlowiec CC, Lavallee M, Mannion EM, Brown MG. An Outcomes Comparison of Native Arteriovenous Fistulae, Polytetrafluorethylene Grafts, and Cryopreserved Vein Allografts. Ann Vasc Surg. 2015;29(8):1642–7. - PubMed
    1. Park HS, Kim WJ, Kim YK, Kim HW, Choi BS, Park CW. et al. Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study. American journal of nephrology. 2016;43(2):120–8. - PubMed

LinkOut - more resources