Abstract: FR-PO773
Maintaining Vascular Access for Haemodialysis after First Vascular Intervention
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Justo avila, Pablo, Royal Derby Hospital, Derby, United Kingdom
- Abd rahim, Terrina, Kettering General Hospital, Leicester, United Kingdom
- Abayasekara, Kumar, Royal Derby Hospital, Derby, United Kingdom
- Chesterton, Lindsay J., Royal Derby Hospital, Derby, United Kingdom
- Fluck, Richard J., Royal Derby Hospital, Derby, United Kingdom
Background
Vascular access (VA) teams struggle with VA patency as they can stenose or thrombose entailing vascular intervention (VI). We explore predicting factors for prolongation of VA function following VI and the role of antiplatelet or anticoagulant medications (AAM) on primary (PGS) and secondary graft survival (SGS).
Methods
We analysed VA formations from Oct09 to Dec15, with follow-up ending Dec16. Patient demographics, comorbidities, cause of ESRD and medications were collated. We identified location of VA, first time of VI, number of VI, failure date and cause of HD withdrawal.
Results
427 patients (260 M and 167 F) underwent VA formation. Mean age was 63 years. 168 had DM (39.3%) and 247 had HTN (57.8%). Causes of ESRD were unknown (41.0%), DM nephropathy (30.4%), GN (21.6%), PKD (3.75%) and HTN nephropathy (3.28%). 315 were on AAM; 19 (3.9%) on warfarin (W), 17 (3.5%) on clopidogrel (CL), 253 (52%) on aspirin (AP), 17 (3.5%) on AP and CL and 9 on W and AP.
538 VA were formed (209 radiocephalic [RC], 229 brachiocephalic [BC], 87 brachiobasilic [BB] and 13 AVGs); 487 usable for HD. Mean follow-up was 850 days (SD 718). 286 (58.7%) required VI; (8 revisions [RV], 278 angioplasty [AG], 33 RV and AG) comprising 116 RC, 109 BC, 51 BB and 10 AVG. Median time to AG was 371 days; while to RV was 443 days. Mean PGS was 356 days (SD 372). Median AG performed was 2.8 (SD 2.25). 153 patients discontinued HD due to death (24.8% [71]), thrombosis of VA (21.7% [62]) and functioning transplant (7%[20]). SGS was 760 days (SD 528).
We excluded patients who died or received transplant from analysis. We found no correlation between having DM or HTN, cause of ESRD, and type of VA with graft patency. VI in the first 6 months after VA formation was associated with worse patency rates (27.27% vs 53.97% [p < 0.001]). HTN was associated with longer SGS (697.73 vs 550.76 days [p 0.004]) whilst DM was associated with shorter SGS (578.76 vs 673.12 days [p 0.039]). AAM was not associated with improved patency (59.09% vs 70.96% [p 0.076]) or SGS (626 vs 656 days [p 0.178]).
Conclusion
1. VI in the first 6 months after VA formation is associated with worse patency rates.
2. Less stringent BP control but tight glycaemic control could potentially increase patency rates of VAs.
3. AAM is not directly associated with higher patency rates or prolongation of SGS.