A comparison of Outcomes Between Open and Endovascular Arteriovenous Access Creation for Hemodialysis

Abstract

Preliminary outcomes for percutaneous endovascular autogenous access (endoAVF) have shown promising results; however, comparisons with surgical cohorts in dialysis populations are lacking. The present study compared autogenous arteriovenous access created using the EverlinQ endoAVF system (TVA Medical, Becton Dickinson Co., Franklin Lakes, NJ) with accesses created by conventional surgical technique with respect to functional- and patency-related outcomes. We performed a multicenter, retrospective review of autogenous arteriovenous accesses entered into a prospective database. Patients undergoing radiocephalic, brachiocephalic, or endoAVF arteriovenous accesses from 2014 to 2019 were included. Autogenous access maturation, primary patency, secondary patency, steal syndrome, and reinterventions were collected and analyzed using standard statistical and survival analyses. A total of 369 accesses were created during the study period, including 61 endovascular accesses, 171 radiocephalic accesses, and 137 brachiocephalic accesses (median follow-up, 17 months; range, 0-71 months). Maturation failure at the end of follow-up was 26.5% ± 6%, 27.0% ± 5%, and 18.4% ± 4% for endovascular, radiocephalic, and brachiocephalic accesses, respectively (P = .049 for brachiocephalic vs endovascular access). The primary patency rates at 12 and 24 months were 42% ± 5% and 32% ± 7% for endovascular access, 43% ± 4% and 24% ± 4% for radiocephalic access, and 42% ± 4% and 29% ± 4% for brachiocephalic access, respectively (P = NS). The secondary patency rates at 12 and 24 months were 68% ± 6% and 61% ± 7% for endovascular access, 75% ± 3% and 67% ± 4% for radiocephalic access, and 87% ± 3% and 81% ± 4% for brachiocephalic access, respectively (P = .019 for brachiocephalic vs endovascular access). No statistically significant differences were found in ischemic steal syndrome (3.3%, 4.1%, and 8.0%; P = .229) or total reinterventions annually (0.8 ± 2.0, 0.9 ± 1.6, and 1.2 ± 1.7; P = .120) for endovascular, radiocephalic, or brachiocephalic arteriovenous access, respectively. EndoAVF compared favorably with respect to maturation and patency with surgically created access in a real-world cohort. The outcomes and reintervention rates were similar to those with conventional radiocephalic arteriovenous access but inferior with respect to patency and maturation compared with brachiocephalic access.