Early-Access Upper Extremity Grafts Offer No Benefit Over Standard Grafts in Hemodialysis Access
John DelBianco, BA, Samuel Steerman, MD, David Dexter, MD, Sadaf Ahanchi, MD, Gordon Stokes, MD, Sarah Ongstad, MD, Obie Powell, MD, Niraj Parikh, MBBS, Jean Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES: To compare the patency, tunneled dialysis catheter (TDC) days, and complications of early-access arteriovenous grafts (EAG) and standard arteriovenous grafts (AVG).
METHODS: A retrospective chart review was conducted on patients who received an expanded polytetrafluoroethylene (ePTFE) AVG from January 2011 to March 2012. HeRO grafts and lower extremity AVGs were excluded. The primary endpoints were primary, primary-assisted, and secondary patency, and the number of days from index operation until TDC removal, termed “catheter days.” The secondary endpoint was the number of access-related complications, including infection and steal.
RESULTS: 122 ePTFE AVGs were placed in 115 patients; 78 were standard AVGs and 44 were EAGs. The standard AVG group included 15 Propaten, 10 Gore Hybrid, 22 Advanta, 4 Impra, 21 Venaflo, and 6 Carboflo grafts. The EAG group included 3 Vectra, 18 Flixene, and 23 Acuseal grafts. The mean age was 66 years and 41% were male. The age, gender, race, BMI, and comorbidities were similar between both groups. Mean follow-up was 16 months (15 in standard group vs 18 in EAG group, p=.368). The standard AVG was the first-ever arteriovenous hemodialysis access for 32% of patients, compared to 30% with the EAG (p=.839). By Kaplan-Meier analysis, EAGs and standard grafts did not differ in primary (3% standard vs 2% EAG, p=.096), primary-assisted (7% standard vs 22% EAG, p=.203), or secondary patency (28% standard vs 54% EAG, p=.366) at 12 months. The number of catheter days was not significantly different between the two groups (61 days standard vs 44 days EAG, p=.065). We found the useful life of the grafts to be similar (11.6 months for standard grafts vs 8.6 months for EAG, p=.450). There was no significant difference in the number of re-interventions (2.7 standard vs 2.4 EAG, p=.656), incidence of thrombosis (1.4 standard vs 1.1 EAG, p=.409), infection (0.15 standard vs 0.14 EAG, p=.814) or steal (.35 standard vs .37 EAG, p=.792) over the life of the grafts. The groups were similar in both thirty-day (p=.545) and overall all-cause mortality (p=.395).
CONCLUSIONS: Early-access grafts in our practice were found to have no benefit over standard grafts. The two types of grafts did not differ significantly in primary patency, primary-assisted patency, secondary patency, catheter days, number of re-interventions required, or access-related complications.
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