Revision Of Aneurysmal Arteriovenous Access With Immediate Use Graft Is Safe And Avoids Prolonged Use Of Tunneled Hemodialysis Catheters

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> Tunneled dialysis catheters (TDC) in patients requiring long-term dialysis are associated with significantly increased mortality compared to arteriovenous fistulas (AVF). Aneurysmal AVF pose a difficult treatment dilemma for vascular surgeons. We aimed to elucidate the outcomes of aneurysmal AV access revision with aneurysm resection and Artegraft Collage Vascular Graft placement to avoid prolonged TDC use. <h3>METHODS</h3> We reviewed patients with aneurysmal AV access in which the access was revised with aneurysm resection and jump graft placement at a single institution from 2018 to 2021. Outcomes were time to cannulation, reintervention rates, time to reintervention and patency. <h3>RESULTS</h3> A total of 41 patients with revised aneurysmal AV access were studied, of which 26.8% (n=11) had perioperative TDC placement. Three patients were done for emergent bleeding. The cohort was 58.5% male (n=24) with a median age of 58 years (IQR: 49-65). Most patients had brachiocephalic AVF (n=31 [75.6%]). Median follow up time was 315 days. Median time to cannulation was 3 days. Time to cannulation was significantly longer in patients with perioperative TDC as compared with those without TDC (24 days vs 1 day, P<0.001). Reintervention was required in 39.0% of patients (n=16), at median time of 30 days. At 30, 90, and 180 days, primary patency rates were 82.9%, 75.5% and 66.6%, primary assisted patency rates were 92.7%, 85.2% and 76.1%, and secondary patency rates were 100%, 97.4% and 90.9% respectively. <h3>CONCLUSIONS</h3> Revision of aneurysmal AV access with Artegraft as jump graft is safe, with acceptable short and mid-term patency results. This allows dialysis patients to continue to have a functional access, decreasing the need for tunneled catheter and reducing the associated risk of sepsis and increased mortality. This should be considered for all patients with aneurysmal, dysfunctional fistulas to maintain AV access and avoid TDC placement