Clinical outcomes following the surgery of new autologous arteriovenous fistulas proximal to the failed ones in end-stage renal disease patients: a retrospective cohort study

Xianglei Kong,Lijun Tang,Liming Liang,Wei Cao,Lei Zhang,Wei Yong,Nannan Ding,Wenbin Li,Zunsong Wang,Dongmei Xu

doi:10.1080/0886022x.2019.1696210

Abstract

Background: Most prior studies have explored surgery for the treatment of failed autologous arteriovenous fistulas (AVFs) with limited follow-up times and a lack of end point mortality. Accordingly, we conducted a retrospective cohort study to evaluate the clinical outcomes of the surgery of new AVF proximal to the failed forearm AVF.Methods: In this study, 538 end-stage renal disease patients (group A, 418 with primary AVF; and group B, 120 with failed AVF) were consecutively enrolled between January 2013 and June 2016, with a median follow-up time of 41 months. Primary and secondary patency, all-cause mortality, and risk factors associated with AVF failure were explored by the Kaplan–Meier method or Cox proportional hazards model.Results: In group A (n = 418), the primary and secondary patencies of AVF were 85.6% vs. 96.8%, 79.7% vs. 95.0%, 75.1% vs.93.9%, 73.2% vs. 93.6% and 73.2% vs. 93.6% at 12, 24, 36, 48 and 60 months, respectively. The primary patencies of AVF in group B were 95.0%, 91.7%, 89.2%, 88.3% and 88.3% at 12, 24, 36, 48 and 60 months, respectively. After adjusting for potential confounders, age, angiotensin-converting inhibitors or angiotensin-receptor blockers (anti-RAAS) drugs and D-dimer were independent predictors of AVF failure. However, there were no differences between functional and failed AVF regarding all-cause mortality.Conclusions: The study revealed that the primary and secondary patiencies of the surgery of new AVF proximal to the failed ones were ideal operations to restore failed forearm AVF.

Highlights

Autologous arteriovenous fistula (AVF) is the preffered access for most patients receiving maintenance hemodialysis (HD), and associated with lower mortality and lower infection rates compared with the other two modalities of vascular access used for chronic HD [1,2]
The significance of bold values represents the p values less than .05. aHR was adjusted for age and sex. bHR was adjusted for age, gender, smoking, hypertension, diabetes, Cardiovascular disease (CVD), anti-RAAS drugs, statins, antiplatelet drugs, hemodialysis, hemoglobin, calcium, phosphorus, parathyroid hormone (PTH), serum albumin, triglycerides, total cholesterol, uric acid, creatinine, D-dimer
From Dialysis Outcomes and Practice Patterns Study (DOPPS) 1 to 5, the percentage of AVF created in the lower arm was consistently 93% in Japan, but this value declined from 70% (DOPPS 1) to 32% (DOPPS 5) in the United States; Successful AVF use was 87% in Japan, and only 64% in the United States [3]

Summary

Introduction

Autologous arteriovenous fistula (AVF) is the preffered access for most patients receiving maintenance hemodialysis (HD), and associated with lower mortality and lower infection rates compared with the other two modalities of vascular access (central venous catheters and grafts) used for chronic HD [1,2]. Thrombosis and stenosis are the main causes of AVF failure, and the anatomic abnormalities of AVF caused by stenosis contributes to the enhancement of thrombosis [5] These clinical practices have considered access procedures to include endovascular interventions such as angioplasty, thrombolysis, thrombectomy, or surgical revisions. Most prior studies have explored surgery for the treatment of failed autologous arteriovenous fistulas (AVFs) with limited follow-up times and a lack of end point mortality. We conducted a retrospective cohort study to evaluate the clinical outcomes of the surgery of new AVF proximal to the failed forearm AVF. All-cause mortality, and risk factors associated with AVF failure were explored by the Kaplan–Meier method or Cox proportional hazards model.

Methods

Results

Discussion

Conclusion