Outcomes of a Polytetrafluoroethylene Hybrid Vascular Graft with Preloaded Nitinol Stent at the Venous Outflow for Dialysis Vascular Access

Abstract

To evaluate outcomes and patency of arteriovenous grafts (AVGs) created using Gore hybrid vascular grafts in hemodialysis patients with limited venous outflow or challenging anatomy. A retrospective review was performed in two academic centers of all patients between July 2013 and December 2016 who underwent surgical AVG creation using a Gore hybrid vascular graft in a brachial artery to axillary configuration. Patient characteristics and comorbidities as well as graft patency, function, and subsequent need for percutaneous interventions were recorded. Forty-six patients including 30 females (65.2%) and 16 males (34.8%) with a mean age of 63±13years were identified. The most common indications for a hybrid vascular graft were limited surgical accessibility and/or revision of existing AVG due to severe stenotic lesions at the venous outflow in 33 patients (72%). One-year primary unassisted and assisted patency rates were 44±8% and 54±8%, respectively, compared with 1-year secondary patency rate of 66±8%. The rate of percutaneous interventions to maintain graft function and patency was approximately one intervention per graft per year. Access created with the hybrid vascular graft in a brachial-axillary (brachial artery to axillary vein) configuration is an acceptable option for patients with limited venous outflow reserve and challenging anatomy. Twelve-month primary and secondary patency rates and need for percutaneous interventions were comparable to traditional AVGs.