Arteriovenous Access Creation For Long-term Therapeutic Apheresis: Reassessment Is Warranted
Christopher Cordes, MD, Christopher Carsten, III, MD, Jonathan Sexton, MD.
Prisma Health, Greenville, SC, USA.
Objective: This study was designed to assess the outcomes at our institution of arteriovenous accesses created for long term therapeutic apheresis. Methods: A single institution, prospectively maintained database was used to identify all patients who underwent AV fistula creation or AV graft placement for therapeutic apheresis between 2007 and 2019. Indications for apheresis included sickle cell disease, myasthenia gravis, Guillain-Barre syndrome, and chronic demyelinating polyneuropathy (CIDP). Patient records were reviewed for demographics, comorbidities, prior catheter, access procedures, interventions, and patency. Results: During our study period, 57 AV accesses were created in 43 patients with intention for utilization for apheresis. These patients were either African-American (53.5%) or white (46.5%), predominantly female (53.5%), with a mean BMI of 27.2. Indications for apheresis included sickle cell disease, myasthenia gravis, Guillain-Barre syndrome, and chronic inflammatory demylinating polyneuropathy (CIDP). AV fistulas were the predominant access created, with 53 (93%) fistulas versus 4 (7%) AV grafts. Of the 57 AV accesses placed, 41 (71.9%) achieved functional patency over a mean of 92.7 days. They required an average of 2.5 interventions to achieve assisted primary or maintain secondary patency. One fistula developed a surgical site infection, but there were otherwise no infectious complications associated with AV access utilization. Of the 41 (71.9%) of AV access creations reaching functional maturity with documented successful utilization for apheresis, the 3 month, 1 year, and 3 year cumulative patency rates were 95.1%, 80.5%, and 58.5%, respectively. Twenty-six (45.6%) patients had a patent access still successfully being utilized for apheresis at the conclusion of the study. Conclusion: In contrast to recent literature suggesting poor outcomes for AV access creation and utilization for apheresis, the experience at our institution has demonstrated accesses created for this study population to be successful and durable, regardless of co-morbidities, previous catheters, indication for apheresis, or fistula type.
| Number of access creations | 57 (43 patients) |
| Access creations achieving functional patency | 41 (71.9%) |
| Cummulative 3 month patency of functional accesses | 35 (95.1%) |
| Cummulative 1 year patency | 33 (80.5%) |
| Cummulative 3 year patency | 26 (58.5%) |
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