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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Arteriovenous graft patency outcomes and prognostic factors
Jeeeun Park1, Jinhae Kim2, Subin Hwang3
11 Division of Nephrology, Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Gangwon-do, South Korea.
Insights
Arteriovenous graft patency for hemodialysis is often poor. Factors like patient age, anastomosis location, low blood pressure, albumin, and hemoglobin impact graft survival, suggesting potential for modifiable interventions.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous grafts (AVGs) for hemodialysis exhibit inferior outcomes compared to arteriovenous fistulas, primarily due to frequent stenosis and thrombosis.
- Understanding factors influencing AVG patency is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the primary and secondary patency rates of arteriovenous grafts used for hemodialysis access.
- To identify prognostic factors associated with arteriovenous graft patency outcomes.
Main Methods:
- A single-center cohort study included 225 patients receiving arteriovenous grafts for hemodialysis from 2010 to 2014.
- Data collected included demographics, comorbidities, medications, and surgical factors.
- Kaplan-Meier survival analysis and univariate/multivariate analyses were performed to assess patency and prognostic factors.
Main Results:
- Over a mean follow-up of 583 days, 61% of grafts required intervention and 20% failed permanently.
- Primary patency rates at 1, 2, and 3 years were 42%, 20%, and 16%, respectively.
- Secondary patency rates at 1, 2, and 3 years were 85%, 72%, and 64%, respectively. Increasing age and specific anastomosis locations negatively impacted primary patency, while higher diastolic blood pressure, serum albumin, and hemoglobin levels improved secondary patency.
Conclusions:
- Diminished primary arteriovenous graft patency is linked to increased patient age and specific anastomosis locations.
- Lower secondary patency correlates with low diastolic blood pressure, low serum albumin, and hemoglobin levels below 10 g/dL.
- Modifiable factors such as blood pressure, serum albumin, and hemoglobin present opportunities to enhance arteriovenous graft patency.
Objectives:
Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes.
Methods:
We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded. Outcomes included primary and secondary patency. Survival analysis was conducted using the Kaplan-Meier method; univariate and multivariate analyses were used to evaluate the prognostic factors.
Results:
Data from 225 grafts were analyzed. During the follow-up period (mean: 583 days, range: 1-1717 days), 138 (61%) grafts required intervention and 46 (20%) permanently failed. Primary patency at one, two, and three years was 42%, 20%, and 16%, respectively. Secondary patency at one, two, and three years was 85%, 72%, and 64%, respectively. Multivariate analysis showed that primary patency was negatively associated with increasing age and location of vessel anastomosis (reference-brachiobrachial anastomosis; brachiobasilic - HR, 0.569; 95% CI, 0.376-0.860; p = 0.007; brachioaxillary anastomosis - HR 0.407; 95% CI, 0.263-0.631; p < 0.0001); secondary patency was positively associated with diastolic blood pressure, serum albumin level, and hemoglobin over 10 g/dL. Adverse events other than stenosis or thrombosis, such as infection/inflammation or pseudoaneurysm were observed in approximately 20% of grafts.
Conclusions:
Factors associated with diminished primary arteriovenous graft patency included increased patient age and location of vessel anastomosis (brachiobrachial type compared to brachiobasilic or brachioaxillary type); diminished secondary patency was associated with low diastolic blood pressure, low serum albumin, and hemoglobin level under 10 g/dL. Among these factors, diastolic blood pressure, serum albumin, and hemoglobin level may be modifiable and could improve arteriovenous graft patency outcomes.
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