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Fistula first, graft on arterialized vein second
Giuseppe Galzerano1, Michele Giubbolini2, Francesco Setacci3
1Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy galzerano.giuseppe@gmail.com.
Vascular
|July 6, 2014
Summary
Arterializing veins before placing grafts (GAV) may prevent vein stenosis and improve outcomes compared to standard arteriovenous grafts (AVG) in native veins (GNV). Further research is encouraged due to promising, though borderline, results.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Arteriovenous grafts (AVGs) are crucial for vascular access in patients unsuitable for autogenous fistulas (AVFs).
- Venous stenosis is a common complication limiting AVG longevity.
- Grafting onto an arterialized vein (GAV) is an alternative to standard AVG in native veins (GNV).
Purpose of the Study:
- To compare the vein stenosis prevention rate between GAV and GNV.
- To assess the impact of vein arterialization on AVG patency.
Main Methods:
- A cohort study from January 2009 to November 2012 included patients undergoing AVG.
- Patients were divided into GAV (arterialized vein) and GNV (native vein) groups.
- Ultrasound follow-up and Kaplan-Meier analysis with Log-rank testing were employed.
Main Results:
- Forty-six AVGs were placed: 20 in GAV (Group A) and 26 in GNV (Group B).
- The 41-month patency rate was 84.3% for GAV versus 43.7% for GNV (p=0.06).
- Secondary patency rates were similar between groups.
Conclusions:
- Vein arterialization appears to reduce venous stenosis, potentially improving AVG patency.
- While results are borderline significant, they suggest GAV as a promising strategy.
- Further studies are warranted to confirm these findings.