Long-term survival of vascular accesses in a large chronic hemodialysis population

Area of Science:

• Nephrology
• Vascular Surgery
• Dialysis Access

Background:

• Vascular access complications represent a significant cause of morbidity and hospitalization in chronic hemodialysis patients.
• The choice of vascular access, either arteriovenous fistula (AVF) or arteriovenous graft (AVG), impacts long-term outcomes.

Purpose of the Study:

• To compare the long-term patency and complication rates of arteriovenous fistulas versus arteriovenous grafts in patients undergoing chronic hemodialysis.
• To evaluate the effectiveness of declotting or revision procedures for failing grafts.

Main Methods:

• A retrospective evaluation of vascular access patency and complications was conducted.
• Two patient cohorts were analyzed: 76 non-diabetic patients on dialysis for ≥3 years and 41 diabetic patients on dialysis for ≥2 years.
• Patency duration (months) and infection rates were compared between AVFs and AVGs.

Main Results:

• Arteriovenous fistulas exhibited significantly longer functional patency compared to grafts in both non-diabetic (58 vs. 22 months, p < 0.01) and diabetic patients (70 vs. 22 months, p < 0.01).
• Declotting or revision procedures for grafts provided only short-term functional restoration (< 6-10 months) and were ultimately ineffective.
• Infection rates were notably lower in fistulas (1 per 200 years of dialysis) than in grafts (1 per 13.5 years of dialysis).

Conclusions:

• Arteriovenous fistulas are superior to arteriovenous grafts for long-term vascular access in chronic hemodialysis patients due to superior patency and lower infection rates.
• Repeated interventions for graft failure are generally ineffective for sustained function.
• The findings support the preferential use of fistulas for initiating and maintaining hemodialysis vascular access.