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Abstract: FR-PO713

Comparison of the Outcomes of Upper Arm Arteriovenous Fistula and Forearm Arteriovenous Graft

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Bian, Xueqin, Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
  • Luo, Yuan, Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
  • Ye, Hong, Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
  • Yang, Junwei, Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
Background

Forearm arteriovenous graft (AVG) and upper arm arteriovenous fistula (AVF) are secondary choices when forearm AVF fails or the vascular quality is poor because of the increased hemodialysis duration or primary disease, such as diabetes. In this study, we compared the outcomes of upper arm AVF and forearm AVG in our dialysis center.

Methods

Patients underwent upper arm AVF or forearm AVG in our hospital from October 2014 to December 2017 were enrolled. The primary and secondary patency, complications were compared between the two groups. Kaplan-Meier survival curves and univariate Cox proportional hazard models were used.

Results

There were 116 (55.2%) patients underwent AVF and 94 (44.8%) patients underwent AVG, respectively. The characterizations of the patients, including age, gender, primary renal disease, comorbidities, hemodialysis duration and previous fistulation history were similar between the two groups. The primary patency of AVG vs. AVF were 83.5% vs. 93.1%, 75.8% vs. 91.4%, 60.3% vs. 75.3%, 42.1% vs. 56.6%, 31.6% vs. 57.1% at 3, 6, 12, 24, 36 month after the surgery, respectively; however, no significant differences were observed between the two groups (P=0.13). Compared with AVF, AVG has higher secondary patency (P=0.03), which were 94.7% vs. 93.1% , 95.6% vs. 91.4%, 85.7% vs. 80.4% , 73.6% vs. 66.0% , 68.4% vs. 57.1% at 3, 6, 12, 24, 36 month after the surgery, respectively. The incidences of complications were higher in AVG than AVF, including thrombosis (23.3% vs. 13.4%), stenosis (50.0% vs. 21.2%), infection (2.4% vs. 0.5%) and steal syndrome (2.4% vs. 1.7%). In all kinds of comorbidities, fistulation history was correlated with reduction of primary patency (HR: 0.42; 95% CI: 0.26 to 0.67) and secondary patency (HR: 0.44; 95% CI: 0.28 to 0.69) in AVF group but not in AVG group.

Conclusion

Forearm AVG has superiority in secondary patency than upper arm AVF. AVG has more complications than AVF. Upper arm AVF may be recommended to increase primary patency and reduce complications.

Funding

  • Government Support - Non-U.S.