Hemodialysis vascular access: upper extremity graft versus anterior chest wall graft

The primary goal of this study was to compare two types of grafts used for vascular access in patients on chronic hemodialysis. The population of interest includes patients on chronic hemodialysis who have had both an upper extremity arteriovenous graft and an anterior chest wall arteriovenous graft (n = 23). In addition to comparing the time to first intervention, the primary and secondary patency rates of the two types of grafts were evaluated. Medical record review was used to gather information related to the placement of the vascular access. The correlated t-test was utilized to analyze the data. Although the trend towards longer time to first intervention with the chest wall grafts was demonstrated numerically, significance was not reached statistically. However, analysis of the secondary findings revealed that both the primary and secondary patency rates were longer in the anterior chest wall graft group. The chi square test was used to analyze the patency rates and statistical significance was reached for secondary patency rate at 3 months with chi2 (1) = 10.1, p < .01. The findings of this study are promising in regards to the patency rates of the anterior chest wall grafts. Future research should include an expanded study of both primary and secondary patency rates in the chest wall graft looking at their patency at 6, 12, and 18 months. Because of the aging population on hemodialysis and the higher acuity of these patients, alternate vascular access sites are going to be a priority.