SummaryBackground and objectives Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts.Design, setting, participants, & measurements Vascular accesses of 1140 hemodialysis patients from two centers (Toronto and London, Ontario, Canada, 200022010) were analyzed. Cumulative patency was compared between groups using Kaplan-Meier survival curves and log-rank tests. Hazard ratios (HRs) for fistula failure relative to grafts and 95% confidence intervals (95% CIs) are reported.Results There were 1012 (88.8%) fistulas and 128 (11.2%) grafts. The primary failure rate was two times greater for fistulas than for grafts: 40% versus 19% (P,0.001). Cumulative patency did not differ between fistulas and grafts for the patients' first access (median, 7.4 versus 15.0 months, respectively [HR, 0.99; 95% CI, 0.7921.23; P=0.85]) or for 600 with a subsequent access (7.0 versus 9.0 months [HR, 0.93; 95% CI, 0.7721.13; P=0.39]). However, when primary failures were excluded, cumulative patency became significantly longer for fistulas than for grafts for both first and subsequent accesses (61.9 versus 23.8 months [HR, 0.56; 95% CI, 0.4320.74; P,0.001] and 42.8 versus 15.9 months [HR, 0.56; 95% CI, 0.4420.72; P,0.001]). Results were similar for forearm and upper-arm accesses. Compared with functioning fistulas, grafts necessitated twice as many angioplasties (1.4 versus 3.2/ 1000 days, respectively; P,0.001) and significantly more thrombolysis interventions (0.06 versus 0.98/1000 days; P,0.001) to maintain patency once matured and successfully used for dialysis.Conclusions Cumulative patency did not differ between fistulas and grafts; however, grafts necessitated more interventions to maintain functional patency.

V-POSSUM scores in this series accurately predicted early mortality after RAAA surgery. The RA-CUSUM method allows for the prospective evaluation of outcomes, while taking into account patient variability. In the current study, this resulted in the identification of a series of patients who had improved outcomes compared with predicted.

Postoperative transient renal dysfunction occurred in 37.3% of patients after open juxtarenal AAA repair, with a low incidence of dialysis and a low rate of permanent dysfunction. Technical factors including renal ischemia time, aortic clamp position, and left renal vein division are the strongest predictors of renal dysfunction. The use of intraoperative mannitol was associated with decreased postoperative renal dysfunction.

During the first several years of follow-up, the proximal thoracic aorta dilates minimally after endovascular repair of BTAIs, with the segment just distal to the left subclavian artery expanding at a slightly greater rate. Longer-term follow-up is necessary to determine whether this expansion continues and becomes clinically significant.