A Single Center Experience with Forearm Arteriovenous Loop Grafts for Hemodialysis

ABSTRACT

Background: Autogenous arteriovenous fistula (AVF) remains the standard of hemodialysis (HD) access, however it cannot be reasonably obtained in all patients. For patients with contraindications to AVFs, prosthetic arteriovenous graft (AVG) remains an alternative. AVGs are plagued by high failure rates, however there is a paucity of literature examining this.

Hypothesis:This study aims to examine a single-center review of outcomes of forearm loop AVGs in patients requiring HD access.

Methods: A single institution, retrospective chart review was completed from 2012-2019, including demographics, ESRD etiology, brachial vessel diameters, and comorbidities. Logistic regression and cox proportional hazard models were evaluated. Outcomes were defined as length of primary patency (time from graft placement to intervention to maintain patency) and secondary patency (time from first intervention until graft failure).

Results: 98 patients [mean age 61.8 (13.9) years, 42.9% female] were identified as having brachial artery to brachial vein AVG creation during the study period. Primary patency was 0.36 (SE 0.07) at six months, 0.12 (0.05) at one year. Secondary patency was 0.75 (0.07) at six months and 0.43 (0.09) at one year.  No association between preoperative vessel diameters and primary or secondary patency was observed.

Conclusions: This study confirms, prosthetic AVGs remain hindered in their utility by high failure rates. Particularly, forearm loop grafts show high rates of graft failure within a year of creation. While this study replicated previous literature demonstrating poor patency rates, a statically significant factor leading to this was not clearly demonstrated. These results draw into question the utility of prosthetic forearm loop grafts in patients requiring long-term HD access.

Source of mentor’s funding or other support that funded this research: No funding