Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use

Abstract

Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts (AVGs) because of longer secondary patency after successful cannulation for dialysis. We evaluated whether access interventions before successful cannulation affect the relative longevity of AVFs and AVGs after successful use. This retrospective study of a prospective database identified patients who initiated dialysis with a catheter and subsequently had a permanent access (289 AVFs and 310 AVGs) placed between January 1, 2006, and December 31, 2011, and were successfully cannulated for dialysis at a large medical center. Patients were monitored until June 30, 2014, and we evaluated the clinical outcomes (secondary patency and frequency of interventions) of the vascular accesses. An intervention before successful cannulation was required more frequently with AVFs than with AVGs (50.5% vs 17.7%; odds ratio, 4.74; 95% confidence interval [CI], 3.26-6.86; P< .0001). Compared with AVFs that matured without interventions, those that required intervention had shorter secondary patency after successful cannulation (hazard ratio, 1.84; 95% CI, 1.30-2.60; P< .0001) and required more interventions per year after successful use (rate ratio [RR], 1.81; 95% CI, 1.49-2.20; P< .0001). Similarly, AVGs that required intervention before successful cannulation had shorter secondary patency than those without prior intervention (odds ratio, 1.98; 95% CI, 1.52-4.02; P<.0001) and required more interventions per year after successful use (RR, 1.49; 95% CI, 1.27-1.74; P< .0001). AVFs requiring intervention before maturation had inferior secondary patency compared with AVGs that were cannulated without prior intervention (hazard ratio, 1.45; 95% CI, 1.08-2.01; P= .01), but required fewer annual interventions after successful use (RR, 0.57; 95% CI, 0.49-0.66; P< .0001). The patency advantage of AVFs over AVGs is no longer evident in patients requiring an AVF intervention before successful cannulation, but the AVFs require fewer interventions after successful use.