Abstract
Objective:To compare the patency control of dysfunctioning forearm arteriovenous graft (AVG) using percutaneous transluminal angioplasty (PTA) in patients with loop versus straight grafts.Materials and Methods:Between January 2012 and March 2017, hemodialysis patients with forearm AVG were treated with PTA at two hospitals. We reviewed technical and clinical success rates of each procedure. Procedure time and patency of the graft were compared for all patients as well as for subgroups of stenosis only and thrombosis using paired-sample t-test and Kaplan-Meier analysis.Results:Sixty-six patients (mean age, 62.11 ± 11.85 years) underwent PTA. Thirty-eight patients (58%) had loop grafts and 28 (42%) had straight grafts. Among 66 patients, 54 (82%) had thrombosis. Technical success rate was 95.5% (only stenosis: 100%; thrombosis: 94%) and the mean procedure time was 48.00 ± 16.75 minutes in all patients. Although there was a tendency towards shorter procedure time in patients with loop grafts (45.24 ± 20.24 minutes) than those with straight grafts (51.85 ± 22.76 minutes), the difference was not statistically significant (p = 0.217), with or without thrombi. There was no statistical significance in primary and assisted primary patency (log rank 0.78, p = 0.38 in primary patency; log rank 0.88, p = 0.35 in assisted primary patency).Conclusion:Our study suggests there is no different patency outcome between straight and loop arteriovenous grafts after PTA.
Highlights
Hemodialysis plays an important role in patients with chronic kidney disease [1, 2]
From January 2012 to March 2017, hemodialysis patients with arteriovenous graft (AVG) failure treated by percutaneous transluminal angioplasty (PTA) were retrieved from the records of two hospitals (Hanyang University Hospital and Hanyang University Guri Hospital)
Kim et al: Outcome of Percutaneous Intervention in Dysfunctional Loop versus Straight Arteriovenous Grafts in Hemodialysis Patients venous pressure causing difficulty in hemostasis, abnormal urea recirculation, abnormal physical findings and unexplained decrease in dialysis dose
Summary
According to internationally recognized guidelines, in patients who need hemodialysis, it is reasonable to have arteriovenous access such as arteriovenous fistula or arteriovenous graft (AVG). It is further suggested that if patients have enough time, native arteriovenous fistula is preferable to an AVG related to superior patency rate [3]. AVGs are created as either an upper arm straight graft with communication between the brachial artery with axillary or basilic vein, or a forearm loop graft with communication between the brachial artery and antecubital vein in the antecubital fossa. Forearm straight grafts are developed with communication of the radial artery with the antecubital, basilic, or brachial veins [4,5,6]. The type of AVG is dependent on the patient’s vascular condition and the surgeon’s preference
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