Inferiority of arteriovenous grafts, in comparison to autogenous fistulas, is underestimated by standard survival measures alone

Abstract

Background It has been argued that a prosthetic arteriovenous graft (AVG) is a reasonable alternative to an arteriovenous fistula (AVF) for dialysis. We aimed to compare the patency rates and requirements for the intervention of newly formed AVF and AVG. Methods A retrospective analysis was undertaken of AVF and AVG formed between 1 January 2013 and 31 December 2015 at two tertiary referral centres and followed up until 31 December 2017. Outcome measures included successful use for dialysis, patency rates and the number of interventions required to maintain dialysis access per patient‐year (PPY). Results Four hundred and seventy AVF and 92 AVG were constructed. Of 470 AVF, 324 (68.9%) were used compared to 80 of 92 (87%) AVG. One year assisted primary patency of AVF was 75% (confidence interval 71–79%) compared to 47% (confidence interval 36–57%) for AVG. Secondary patency rates for AVF at 1, 2 and 3 years were 77%, 71% and 69%, respectively. At the same time points, secondary patency rates for AVG were 77%, 60% and 46%, respectively (log rank P = 0.034). AVG required 2.4 times the number of interventions PPY than AVF. Surgical thrombectomy of AVG was at a rate of 0.49 PPY compared with 0.042 PPY for AVF. Conclusion AVG have a substantially higher rate of thrombosis than AVF, evident from early in the life of the graft. AVF demonstrate superior patency rates to AVG throughout the life of the access, with far fewer interventions PPY than grafts.

Receiver operating characteristic curve analysis of arteriovenous dialysis access flow using ultrasound

“…Many patients had multiple comorbidities of which hypertension was the most common. Other comorbidities include ischaemic heart disease, peripheral vascular disease, diabetes, high lipid profile and previous cerebral vascular accidents as reported previously 8 …”

“…Patients using catheters or prosthetic arteriovenous grafts for haemodialysis were excluded due to the low prevalence of graft use in our institution. 8 Clinical data was retrieved from the electronic medical records of the dialysis database and ultrasound parameters from archived radiological images. Ethics approval for the study was provided by the Institutional Review Board of Monash Health, Victoria, Australia.…”

“…We performed a retrospective analysis of a prospectively collected database of haemodialysis patients who underwent US investigation of their forearm AVF or upper arm AVF between 1 January 2016 and 31 December 2018, in a single tertiary institution. Patients using catheters or prosthetic arteriovenous grafts for haemodialysis were excluded due to the low prevalence of graft use in our institution 8 …”

Optimal flow volume measurements in forearm versus arm arteriovenous fistulas

“…Patients using catheters or prosthetic AVG for haemodialysis were excluded due to the low prevalence of graft use in our institution. 15 The clinical data and ultrasound parameters from archived radiological images were studied. This study was approved by the ethics committee of the Institutional Review Board of Monash Health, Victoria, Australia.…”

“…All haemodialysis patients who underwent DUS investigations of autologous AVF over 2 years were followed until June 2019 and all scans were subsequently analysed. Patients using catheters or prosthetic AVG for haemodialysis were excluded due to the low prevalence of graft use in our institution 15 . The clinical data and ultrasound parameters from archived radiological images were studied.…”