Arteriovenous graft patency outcomes and prognostic factors: A single-center study

Abstract

Aim/Purpose: Functional, long-lasting vascular access is essential for maintaining effective long-term hemodialysis. Various factors including demographics and comorbid conditions have influenced the patency rates. As per the KDOQI reports, vascular access-related complications account for 15%–20% of hospitalizations in end-stage renal disease (ESRD) cases. This study aims to analyze various factors and to study the patency rates and complications of brachioaxillary arteriovenous (AV) prosthetic grafts for dialysis access at a single center. Materials and Methods: This was a single-center prospective study, which was conducted in Ramaiah Medical College Hospital, Bengaluru. All patients who underwent brachioaxillary AV prosthetic graft surgery for dialysis access over a period of 5 years from July 2012 to June 2017 were included. Follow-up of cases was done up to 2 years, and any complications encountered during the study period were recorded. Results: A total of 408 patients were included, in which 77% were male, with a mean age of 60.1 years. The most common comorbidity associated was hypertension (68%) followed by diabetes (36%), and the mean axillary vein diameter was 5.2 mm. The primary patency rates at the end of 1 and 2 years were 61.5% and 49%, respectively, and the secondary patency rates at the end of 1 and 2 years were 70% and 59%, respectively. Conclusions: In ESRD patients, in whom an autogenous fistula is not possible, prosthetic AV grafts are a suitable choice for vascular access and provide satisfactory patency rates for hemodialysis access. Thrombosis, secondary to venous intimal hyperplasia, is the most common complication and generally occurs by the 3rd month. Interventions will improve long-term patency rates and should consist of thrombectomy and thrombolysis in addition to balloon angioplasty. However, complications will still be encountered and their early recognition with aggressive surveillance and appropriate management is necessary to prolong overall graft survival.