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Functional Impairment Is Associated With Poor Outcomes After Arteriovenous Access Creation
Scott R. Levin, MD, MSc, Alik Farber, MD, MBA, Elizabeth G. King, MD, Alan G. Perry, BA, Thomas W. Cheng, MS, Jeffrey J. Siracuse, MD, MBA.
Boston University School of Medicine, Boston, MA, USA.

OBJECTIVES: Functional impairment affects outcomes after a variety of procedures. However, the impact of functional impairment on outcomes of arteriovenous (AV) access creation is unclear. We aimed to evaluate the relationship of patient ambulatory status and ability to independently perform activities of daily living (ADLs) with AV access outcomes.
METHODS: We performed a single center retrospective review of patients undergoing AV access creation from 2014-2020. We evaluated associations of impaired ambulation (with assistance or wheelchair/bedbound) and assisted ADLs with 90-day readmission, 5-year primary patency, and 5-year mortality.
RESULTS: Among 689 patients receiving AV access, mean age was 59.613.9 years, 59% were male sex, and 60% were black. Ambulation was impaired in 243 (35%) and ADLs were assisted in 122 (18%) patients. Accesses included brachiocephalic (43%), brachiobasilic (25%), radiocephalic (13%), and other (5%) fistulas and grafts (14%). On univariable analysis, patients with impaired ambulation or assisted ADLs were more likely to be older or have diabetes, congestive heart failure, coronary artery disease, or previous stroke (all P<.05). Patients with impaired ambulation were significantly more likely to be readmitted within 90 days (85% vs. 77%, P=.01), but not patients with assisted ADLs (88% vs. 80%, P=.06). On Kaplan-Meier analysis, 5-year primary patency was lower for patients with impaired ambulation (10% vs. 20%, P<.001), but not significantly different for patients with assisted ADLs (17% vs. 21%, P=.15). Five-year survival was lower for patients with impaired ambulation (53% vs. 74%, P<.001), but was not significantly different for patients with assisted ADLs (45% vs. 71%, P=.1). On multivariable analysis, impaired ambulation (OR 1.54, 95% CI 0.88-2.7, P=.13) and ADL assistance (OR 1.56, 95%CI 0.83-2.92, P=.17) were not associated with 90-day readmission. Impaired ambulation was independently associated with increased 5-year patency loss (HR 1.67, 95% CI 1.02-2.73, P=.04) and mortality (HR 1.83, 95% CI 1.13-2.96, P=.01), but ADL assistance was not (patency loss: HR 0.97, 95% CI 0.59-1.58, P=0.89; mortality: HR 0.95, 95% CI 0.58-1.56, P=0.84).
CONCLUSIONS: Impaired ambulation was associated with increased 5-year patency loss and mortality after AV access creation. Approximately half of ambulatory-impaired patients were not alive at 5 years. Setting outcome expectations as well as prospectively examining the impact of pre-/post-operative physical therapy and visiting nursing services for functionally impaired patients undergoing access creation are warranted.


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