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Kidney Week

Abstract: SA-PO1112

Comparing Outcomes of Forearm Loop and Arm Curved Configurations 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

We conducted a comparative analysis of outcomes of newly placed proximal upper arm straight grafts (pAVG) and distal forearm loop grafts (dAVG).

Methods

Retrospective, single-center analysis. Incident dialysis patients with newly placed AVGs involving the brachial or radial artery, pAVG or dAVG, were studied from 2015 to 2018. Primary survival (PS), primary assisted survival (APS) and secondary survival (ScS) (months) and patency rates for both conduit configurations were determined. Number of patency maintenance and access salvation interventions were recorded and compared.

Results

Data from 185 patients were analyzed, 108 patients received pAVG and 101 dAVG of loop configuration. PS was demonstrated to be 6.7±1.0 months for pAVG and 6.3±1.1months for dAVG (p=0.925), when APS was 21.7±4.0 for pAVG and 13.0±4.5 for dAVG (p=0.448). ScS was 48.3±5.4 for pAVG and 50.1±5.0 months for dAVG (p=0.829). An average of 3.03±3.76 angioplasty procedures was performed for patency maintenance in pAVG and 4.93±4.78 in dAVG, respectively (p=0.006). Moreover, 0.26±0.55 and 0.74±1.05 stents were deployed in pAVG and dAVG, respectively (p=0.001), with 20.3% of proximal grafts and 44.3% of distal conduits requiring stenting to maintain patency (p=0.002). In 28.6% of pAVGs and 41.9% of dAVGs no access salvation intervention was required, while in 71.4% of pAVGs and 58.1% dAVGs thrombectomy, transluminal thrombolysis or both were performed in order to restore patency, differences that were non-significant (p=0.355). Primary patency was 32% and 17% for pAVG and 28% and 18% for dAVG in 12 and 24 months, respectively. Assisted primary patency was 54%, 41%, 28% and 22% for pAVG and 46%, 35%, 25% and 19% for dAVG in 12, 24, 36 and 48 months, respectively. Secondary patency was 77%, 60%, 50% and 42% for pAVG and 70%, 64%, 52% and 42% for dAVG in 12, 24, 36 and 48 months, respectively.

Conclusion

Distal forearm grafts seem to perform similarly to proximal arm conduits since both configurations serve their respective purpose. Intensive follow-up, access surveillance, pre-emptive patency maintenance interventions are all essential for these outcomes, especially in the distal loop configuration. In order to preserve a maximal number of access sites, the forearm location should be advised to be considered first.