Alexander Chang, Matthew T. Allemang, Schmotzer Brian, Lakin O. Ryan, Woodside J. Kenneth, Wang John, Vikram S. Kashyap, Wong L. VirginiaUniversity Hospitals of Case Western Reserve University, Cleveland, OH.
Renewed interest in arteriovenous fistula (AVF) transposition has arisen as emphasis is being placed on autologous hemodialysis access construction. We report our experience with 1- and 2-stage techniques for AVF transposition.
METHODS: A database of all patients who had AVF placed between January 2008 and June 2011 was retrospectively reviewed. Patients were stratified into those whose AVF was transposed using a 1-stage technique (AVFT-1) and those done with a 2-stage technique (AVFT-2). Outcomes measured were assisted primary and secondary patency. Marginal survival models utilizing Cox Proportional Hazards regression were used for statistical comparison. Results are reported as hazard ratio (HR) and 95% confidence intervals (CI).
RESULTS: A total of 125 AVF were created using a transposition technique. AVFT-1 (n=38) and AVFT-2 (n=87) were analyzed. After accounting for multivariate association with age, diabetes, PAD, tobacco use, previous number of accesses and presence of tunneled catheter at AVF creation, AVFT-2 was associated with both better assisted primary (HR 0.47 [CI 0.25, 0.90 ]) and secondary patency (HR 0.44 [CI 0.23, 0.87]) when compared to AVFT-1.
CONCLUSIONS: In our experience, 2-stage operations demonstrated improved assisted primary and secondary patency and, as a corollary, could extend the duration of autologous access in challenging hemodialysis patients.
M. T. Allemang: Nothing to disclose; S. Brian: Nothing to disclose; A. Chang: Nothing to disclose; W. John: Nothing to disclose; V. S. Kashyap: Nothing to disclose; W. J. Kenneth: Nothing to disclose; L. O. Ryan: Nothing to disclose; W. L. Virginia: Nothing to disclose.
Kaplan-Meier survival curves of secondary patency for one-stage and 2-stage AVF transposition.
Posted April 2013