Annals of vascular surgery · 2025
Upper Extremity Arteriovenous Grafts are Less Likely to be Abandoned Compared to Autogenous Fistulas Despite a Higher Reintervention Rate.
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Patel Nyah, Farber Alik, King Elizabeth, Malas Mahmoud, Alonso Andrea, Chitalia Vipul, Lotfollahzadeh Saran, Columbo Jesse A, Goodney Philip P, Siracuse Jeffrey J, Vascular Quality Initiative, Vascular Implant Surveillance and Interventional Outcomes Network
Аннотация
BACKGROUND: Upper-extremity arteriovenous (AV) access often requires reintervention. However, the frequency of reinterventionsand subsequent access failure is not well-characterized. Our goal was to evaluate the frequency and type of reinterventions, risk-factors, and outcomes after AV access creation.
METHODS: We performed a retrospective review of index upper extremity AV access creations (2017-2019) within the VQI Medicare-linked Vascular Implant Surveillance and Interventional Outcomes Network dataset for patients on hemodialysis (HD). Reinterventionswere defined as open or endovascular procedures on the access occurring at 1 day or more after access creation. Access abandonment was defined as any new access creation, peritoneal dialysis, kidney transplant, or death following index access creation. Univariable, multivariable, Kaplan-Meier, and Cox regression analyses were performed.
RESULTS: There were 2,551 patients with an index AV graft (AVG) (19.5%) or AV fistula (AVF) (80.5%). Patients who underwent an AVG were more likely older, female sex, of non-White race, nonambulatory, not living at home, and to undergo the procedure as an inpatient (P < 0.05). Reintervention rates were 1.64/person-year for AVG and 1.17/person-year for AVF. On Kaplan-Meier analysis, freedom from new AV access creation at 3 years was 72% for AVG and 78% for AVF (P < 0.001). Freedom from tunneled dialysis catheter (TDC) placement at 3 years was 66% for AVG and 71% for AVF (P = 0.19). On multivariable analysis, undergoing placement of an AVG was independently associated with an increased risk of any reintervention compared to AVF (rate ratio (RR) 1.40 95% confidence interval (CI) 1.3-1.6; P = <0.001). TDC placement was increasingly associated with each subsequent reintervention but did not vary by access type. There was an elevated risk of access abandonment with subsequent reinterventions; however, long-term access abandonment was lower with an AVG compared to an AVF (RR 0.82 95% CI 0.7-0.96; P = 0.015).
CONCLUSION: Reinterventions to support HD access are common, and more than 60% of patients required at least one procedure within the first year of access placement. While patients with AVG require more reinterventions, they also have a lower rate of long-term access abandonment and similar rates of TDC placement compared to patients who receive an AVF.
METHODS: We performed a retrospective review of index upper extremity AV access creations (2017-2019) within the VQI Medicare-linked Vascular Implant Surveillance and Interventional Outcomes Network dataset for patients on hemodialysis (HD). Reinterventionswere defined as open or endovascular procedures on the access occurring at 1 day or more after access creation. Access abandonment was defined as any new access creation, peritoneal dialysis, kidney transplant, or death following index access creation. Univariable, multivariable, Kaplan-Meier, and Cox regression analyses were performed.
RESULTS: There were 2,551 patients with an index AV graft (AVG) (19.5%) or AV fistula (AVF) (80.5%). Patients who underwent an AVG were more likely older, female sex, of non-White race, nonambulatory, not living at home, and to undergo the procedure as an inpatient (P < 0.05). Reintervention rates were 1.64/person-year for AVG and 1.17/person-year for AVF. On Kaplan-Meier analysis, freedom from new AV access creation at 3 years was 72% for AVG and 78% for AVF (P < 0.001). Freedom from tunneled dialysis catheter (TDC) placement at 3 years was 66% for AVG and 71% for AVF (P = 0.19). On multivariable analysis, undergoing placement of an AVG was independently associated with an increased risk of any reintervention compared to AVF (rate ratio (RR) 1.40 95% confidence interval (CI) 1.3-1.6; P = <0.001). TDC placement was increasingly associated with each subsequent reintervention but did not vary by access type. There was an elevated risk of access abandonment with subsequent reinterventions; however, long-term access abandonment was lower with an AVG compared to an AVF (RR 0.82 95% CI 0.7-0.96; P = 0.015).
CONCLUSION: Reinterventions to support HD access are common, and more than 60% of patients required at least one procedure within the first year of access placement. While patients with AVG require more reinterventions, they also have a lower rate of long-term access abandonment and similar rates of TDC placement compared to patients who receive an AVF.