Long-term outcomes and influencing factors of lower extremity arteriovenous grafts in hemodialysis patients: a single-center retrospective study.

OBJECTIVE

To investigate the long-term outcomes and influencing factors of lower extremity arteriovenous grafts (AVGs) in maintenance hemodialysis patients.

METHODS

A retrospective analysis was conducted on clinical data from 96 hemodialysis patients who underwent lower extremity arteriovenous graft placement at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2013 and December 2023. Demographic characteristics, laboratory parameters, surgical details, and follow-up outcomes were recorded. Kaplan‒Meier analysis was used to assess patency rates, whereas univariate and multivariate Cox regression models were used to identify predictors of thrombosis and graft failure. The outcomes were defined according to the Society for Vascular Surgery reporting standards.

RESULTS

The cohort had a mean age of 61.3 ± 12.5 years, with 67 females (69.8%) and a mean duration of dialysis of 6.2 ± 4.5 years. The procedures were predominantly left-sided (65.6%), with superficial femoral artery anastomosis (47.9%). The primary patency rates were 29.2%, 13.3%, and 8.9% at 1, 2, and 3 years, respectively [mean 7 (3,16)]. The assisted primary patency rates reached 90.3%, 72.2%, and 64.6%, [mean 34(18,58) months], whereas the secondary patency rates were 94.8%, 94.8%, and 88.3%, [mean 47.5(33.5,68.5) months]. No significant differences were observed across arterial anastomosis types (P > 0.05). The thrombosis rate was 0.20 events per patient-year. Baseline data showed no significant factors influencing thrombosis formation. Prior arteriovenous fistula history reduced the risk of graft abandonment (HR 0.220, 95% CI 0.063–0.764), whereas prior tumor history increased the risk of abandonment (HR 4.106, 95% CI 1.130-14.917).

CONCLUSIONS

Lower extremity arteriovenous grafts demonstrate superior secondary patency rates, independent of arterial anastomosis selection. These grafts represent a viable option for patients with upper extremity central venous stenosis, exhausted vascular access, or hemodynamic instability. CLINICAL TRIAL: Chinese Clinical Trial Registry (ChiCTR), MR-33-25-018188, Retrospectively Registered, Date: 2025-3-4.