Abstract No. 19 - Outcomes of early-cannulation PTFE interposition grafts for salvage of failing arteriovenous fistulae

Abstract

Early cannulation PTFE (Flixene™) is an alternative to conventional PTFE for revision of failed arteriovenous dialysis fistulae, as it enables rapid resumption of hemodialysis without the need for catheter use. We report our institutional experience of early-cannulation PTFE when used as an interposition graft for aneurysmal and/or ulcerated arteriovenous fistulas. A prospective QA database identified 46 dialysis patients (24M: 22F, mean age 63) with aneurysmal (n= 19), ulcerated (n=13), ulcerated and aneurysmal (n=13), or infected (n=1) arteriovenous fistulae over a 54 month period who underwent placement of early-cannulation PTFE (Flixene®) for interposition. These included radiocephalic (n=6), brachiocephalic (n=18), basilic vein transposition (n=14), and cephalic vein transposition (n=8) fistulae. A subset of these patients subsequently presented with a dysfunctional (n=18) or thrombosed (n=3) access. This cohort subsequently underwent a total of 36 percutaneous interventions to maintain access function. Post intervention patency was calculated with the Kaplan Meier technique. Median time from surgical revision to first percutaneous intervention was 125 days (K/DOQI target, 180 days). Interventions including angioplasty (n=30), stent/stent graft placement (n=1), or thrombectomy (n=5) for a total of 0.92 patient-years of dialysis. Primary, assisted primary, and secondary patency following all percutaneous interventions were 54%, 84%, and 90% at 90 days; 38%, 69%, and 82% at 180 days; and 18%, 60%, and 72% at 1 year, respectively (P=0.009). Primary patency following angioplasty alone was 43% at 6 months. 7 interposition grafts (15%) were excised for subsequent infection. Access patency following percutaneous intervention approached the K/DOQI threshold of 50% at 6 months following angioplasty. Significantly higher rates of assisted primary and secondary patency were observed compared to unassisted patency. Early-cannulation PTFE for revision of aneurysmal or ulcerated arteriovenous fistulae should be considered as an alternative to fistula abandonment.