A Single Center Experience With Forearm Arteriovenous Loop Grafts For Hemodialysis

Abstract

<h3>OBJECTIVES</h3> Autogenous arteriovenous fistula (AVF) remains the standard of care for hemodialysis (HD) access, however, it cannot be reasonably obtained in all patients. For patients with contraindications to AVFs, prosthetic arteriovenous graft (AVG) remains an alternative. AVGs are plagued by high failure rates, however, there is a paucity of literature examining this. This study aims to examine a single-center review of outcomes of forearm loop AVGs in patients requiring HD access. <h3>METHODS</h3> A single institution, retrospective chart review was completed from 2012-2019, including patient demographics, end-stage renal disease (ESRD) etiology, brachial artery and vein diameters, and comorbidities. Logistic regression and cox proportional hazard models were evaluated. Outcomes were defined as length of primary patency (time from graft placement to intervention to maintain patency) and secondary patency (time from graft placement until graft failure despite intervention). <h3>RESULTS</h3> 98 patients [mean age 61.8(13.9) years, 42.9% female] were identified as having brachial artery to brachial vein AVG creation during the study period. Primary patency was 0.36 (SE 0.07) at six months, 0.12 (0.05) at one year. Secondary patency was 0.75 (0.07) at six months and 0.43 (0.09) at one year (see figure 1 below). No association between preoperative vessel diameters and primary or secondary patency was observed. <h3>CONCLUSION</h3> Prosthetic forearm loop AVGs remain hindered in their utility as they show high rates of graft failure within a year of creation. A significant patient-specific factor leading to this was not clearly demonstrated. As guidelines change regarding the nature of dialysis access for patients on HD, these results draw into question the utility of prosthetic forearm loop grafts in patients requiring long-term HD access.