Abstract No. 331 - Outcomes of interventions in hybrid hemodialysis access

Abstract

Purpose Fistulae and grafts respond differently to percutaneous interventions, with fistulae generally yielding longer patency. Failing fistulae, whether due to aneurysm or refractory stenosis, may be treated surgically with interposition grafting, creating a “hybrid” access. The purpose of this study was to determine the outcomes of percutaneous interventions in hybrid accesses. Materials and Methods We retrospectively reviewed patient records from a prospectively collected database containing more than 6,000 hemodialysis interventions conducted over a 10-year period. From this database, patients identified as having hybrid access were included; those without follow-up were excluded. The main outcomes investigated were the intervals of primary and secondary patency after percutaneous interventions to maintain or restore function, as defined by SIR guidelines. A sample of synthetic and native hemodialysis access interventions from the same database served as control. Results Of 40 patients with hybrid access, 29 met inclusion criteria. Mean access age for fistulae, grafts, and hybrids was 232±257, 176±232, and 918±953 days respectively. 77 interventions were performed in this group, 737 in the fistula control group, and 603 in the graft control group. Median post intervention primary patency in hybrids was similar to fistulae (166 vs 133 days, P=0.7) and longer than grafts (79 days, P Conclusion Our data suggest that interposition grafting in fistulae to form a hybrid access does not compromise post-intervention patency.