Giuseppe Galzerano1, Michele Giubbolini1, Francesco Setacci1, Gianmarco de Donato1, Pasqualino Sirignano1, Alessandro Cappelli1, Gabriele Messina2, Carlo Setacci1
1Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy; 2Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
OBJECTIVES: Arteriovenous grafts (AVG) present a feasible solution for creating a conduit in patients with end stage renal failure who are unsuitable for autogenous fistula (AVF). Unfortunately, these vascular conduits are fraught with complications and failing access remains the leading cause of hospitalization for patients undergoing dialysis. The aim of this study is to assess the prevention rate of vein stenosis, placing a graft on an arterialized vein (GAV) instead of an anastomosed AVG in a native vein (GNV).
METHODS: This was a cohort study conducted from January 2009 to November 2012. All consecutive patients who underwent AVG in our institution were included. All patients requiring a secondary intervention were also referred to our center. Last follow-up data were recorded by telephonic interviews with the hemodialysis units that had referred patients to our department. Graft closures caused by pseudoaneurysm, death, infections, transplants or related to proximal anastomosis were excluded from the data analysis. A Kaplan-Meier method was used to plot GAV-patency and GNV-patency; a log-rank test was used to identify whether significant difference (p<0.05) existed between GAV and GNV.
RESULTS: During the study, 46 grafts were placed (299 access-related procedures). Twenty patients had arterialized receiving veins (Group A), while 26 patients received an AVG immediately because they lacked autogenous veins suitable for fistula (Group B).The average follow-up period was 16, 1 months (range 0-41). The Group A 41-months patency rate was 84, 3%, while group B was 43, 7% (p=0.06). Secondary patency was similar in the 2 groups.
CONCLUSIONS: Vein arterialization seems to prevent venous stenosis improving AVG-patency rate. This finding increases the significance of fistula first approach even if a transposition or elevation is required, due to the positive results of placing grafts on arterialized vein for failed fistulas. More data are needed to improve statistical value; however, the borderline p-value encourages new studies.
AUTHOR DISCLOSURES: A. Cappelli: Nothing to disclose; G. de Donato: Nothing to disclose; G. Galzerano: Nothing to disclose; M. Giubbolini: Nothing to disclose; G. Messina: Nothing to disclose; C. Setacci: Nothing to disclose; F. Setacci: Nothing to disclose; P. Sirignano: Nothing to disclose.
Posted April 2013