Abstract: SA-PO1111
Evaluating Factors Predicting Outcomes of Secondary Patency of Arteriovenous Grafts for Hemodialysis
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Giannikouris, Ioannis Emmanouel, Medifil SA Private Hemodialysis Center, Athens, ATTIKA, Greece
- Spiliopoulos, Stavros, ATTIKO University Hospital, Athens, Greece
- Kyriazis, Periklis Panos, Beth israel Deaconess Medical Center, Chicopee, Massachusetts, United States
- Scarpati, Luisa, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
- Bacchini, Giuseppe, A. Manzoni Hospital, Lecco, Lombardy, Italy
Background
Our objective was to analyze outcomes in terms of secondary survival (CSS) and secondary patency rate (SPR) of AVG and to determine prognostic factors for these outcomes.
Methods
It was a retrospective, single-center analysis. Incident HD patients that received implantation of an AVG for angioaccess from January 2015 to December 2018 were included. Demographic factors, timing, type, and site of implanted AVG, as well as types of treatment of VA malfunction or failure, were recorded. Outcomes included CSS and SPR in 12, 24, 36 and 48 months. Kaplan-Meier survival analysis was conducted; univariate and multivariate analyses were used to evaluate prognostic factors.
Results
Data from 223 patients were analyzed. Those involved 119 proximal (arm) AVG, 101 loop (forearm) AVG, and 1 leg AVG, of which 147 were ePTFE grafts, 39 acute cannulation AVGs, and 37 biological vascular conduits. CSS was 49±4 months and SPR were 74%, 63%, 52%, 43% in 12, 24, 36 and 48 months, respectively. Multivariate analysis demonstrated that secondary patency was not associated with age, gender, duration in HD, graft position, stent deployment or use of cutting balloon angioplasty. Patency was negatively affected by graft type (acute cannulation HR, 3.09, 95% CI,1.66–5.75, p〈0.005, biological HR, 0.70, 0.39–1.24, p=0.218), presence and number of successfully treated thrombotic events, with differences, noted depending on the type of treatment selected (Fogarty thrombectomy HR, 3.63, 1.89-6.98, p〈0.005, Trerotola thrombolysis HR,3.14,1.53-6.43, p=0.002). A positive correlation was demonstrated between the increasing number of successful pre-emptive angioplasties and VA secondary patency (HR,0.90, 0.83-0.98, p=0.019). After 4.2±4.5 angioplasties per access, the association of CSS and stenosis proved to be weak (HR, 0.74, 0.32-1.70, p=0.474), a finding that requires further analysis.
Conclusion
Factors such as age, site or time on dialysis, traditionally thought to adversely affect access prognosis may not influence secondary outcomes of AVG. The use of new technology conduits, stenting or sophisticated endovascular catheters and declogging techniques may not contribute to prolonging access survival. Prompt stenosis recognition and pre-emptive correction could be a milestone in our continuous challenge for improving patency.