Abstract
To evaluate the long-term patency rate of the arteriovenous angioaccess (AVA) with interposition of either autologous or prosthetic material as a last option for vascular access in the upper extremity. This is a retrospective chart review study of all patients who received an AVA with autologous saphenous vein (SV Group, n = 38) or prosthetic material (PTFE Group, n = 25) as a conduit from the year 1996 to 2020 in the Radboud University Medical Center (Radboudumc). Data were retrospectively extracted from two prospectively updated local databases for vascular access, one for haemodialysis (HD) and one for parenteral nutrition (PN). When required, the medical records of each patient were used. Data were eventually collected anonymously and analysed in SPSS 25. Kaplan-Meier life-tables were used for the statistical analysis. Primary patency at 12 and 48 months was 30% and 20% in the SV group and 45% and 14% in the PTFE group. No significant difference was shown in the median primary patency rate (p = 0.715). Secondary patency at 12 and 48 months was 63% and 39% in the SV group and 55% and 19% in the PTFE group. This was considered a significant difference in median secondary patency in favour of the SV with 41.16 ± 17.67 months against 13.77 ± 10.22 months for PTFE (p = 0.032). The incidence of infection was significantly lower in the SV group (p = 0.0002). A Kaplan-Meier curve could not detect a significant difference in secondary patency between the access for haemodialysis and the access for parenteral nutrition. The secondary patency of the SV in parenteral nutrition access, was significantly higher when compared with PTFE (p = 0.004). The SV can be preferred over PTFE when conduit material is needed for long-term vascular access for HD or PN treatment due to its higher secondary patency and lower infection risk.
Highlights
A vascular access is a lifeline for patients with end-stage kidney disease (ESKD) who need haemodialysis (HD)[1] and in rare cases of chronic intestinal failure (CIF) who need parenteral nutrition (PN).[2]
A total of 63 arteriovenous angioaccess (AVA) were included for all analyses, 38 with SV and 25 with PTFE
Seven AVAs were abandoned because of dysfunction and puncture problems, which was due to fibroses of the great saphenous vein (GSV)
Summary
A vascular access is a lifeline for patients with end-stage kidney disease (ESKD) who need haemodialysis (HD)[1] and in rare cases of chronic intestinal failure (CIF) who need parenteral nutrition (PN).[2]. When the quality of these peripheral vessels are insufficient, more proximal fistulae as the brachiocephalic AVF (BCAVF) or the brachio-basilic AVF (BBAVF) are indicated at the elbow and upper-arm region When these options are impossible or the access has failed, graft implants as a vascular conduit can be considered to construct an AVA. This technique uses looped or straight prosthetic materials, mostly PTFE, that function as a conduit between artery and vein. The results will provide an overview of the quality of the AVA with autologous vein interposition in both patient groups This can lead to the identification of significant factors affecting the patency, infection risk and maybe lead to changes in the protocol of vascular access surgery
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