PC140. Oakes Salvage Procedure Is a Better, More Durable Option Compared With Forearm Loop Expanded Polytetrafluoroethylene Graft to Preserve Forearm Dialysis Access in Patients With Failing Brescia-Cimino Fistula

Abstract

Radiocephalic fistula is an ideal initial autologous option; however, the Brescia-Cimino fistula (BCF) has a significant rate of failure to mature. Historically, these fistulas were abandoned and more proximal access was obtained. In 2002, Oakes described a novel procedure to salvage the distal cephalic venous outflow of a BCF by placing a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist. The durability of the Oakes procedure (Oakes-P) has not been compared with other prosthetic conduits. This study aimed to compare Oakes-P vs a loop forearm graft with expanded polytetrafluoroethylene (ePTFE; loop-ePTFE). All patients who underwent Oakes-P or loop-ePTFE from 2008 to 2015 at a single institution were included. Data points included demographic information, date of fistula placement, date of Oakes-P, days to intervention, type and number of interventions, and infection rates. Statistical analysis included descriptive statistics. There were 14 patients who underwent Oakes-P and 12 patients who underwent loop-ePTFE. All patients had a prior placement of a poorly maturing BCF. The average number of days to placement of an Oakes-P was 396 days; 71% (10) of patients underwent an intervention to maintain the Oakes graft, of whom 50% (5) underwent an angioplasty and 50% (5) had thrombectomy or revision. The average number of days to first intervention was 367.3 days from Oakes-P. Three patients (30%) had a second intervention, of which one (33%) was an angioplasty and two were revisions (66%). The overall number of days the Oakes-P remained usable was 843.6 days or 2.3 years. The primary patency and primary assisted patency for the Oakes-P were 58.3%, 41.6%, and 25.8% and 66.7%, 58.3% and 58.3%. The primary patency and primary assisted patency for the loop-ePTFE were 71.4%, 64.3%, and 57.1%, and 78.6%, 57.1%, and 42.8% at 6, 12, and 24 months. There was a significantly improved primary assisted patency (P = .04) for the Oakes-P. There was no statistical difference in the primary patency rate. There were no deaths attributable to the fistula procedure, and there was one infection in the loop-ePTFE cohort. Oakes-P is a viable option for patients who have a poorly maturing BCF. We observed that the Oakes-P extends the use of a poorly maturing BCF and should be considered before placement of a loop-ePTFE.