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Greenberg J, Jayarajan S, Reddy S, Schmieder FA, Roberts AB, van Bemmelen PS, Lee J, Choi ET. Long-Term Outcomes of Fistula First Initiative in an Urban University Hospital-Is It Still Relevant? Vasc Endovascular Surg 2017; 51:125-130. [PMID: 28330437 DOI: 10.1177/1538574417692454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Dialysis access failure is a major cause of morbidity in patients with end-stage renal disease. The Fistula First Breakthrough Initiative (FFBI) dictates arteriovenous fistulae (AVFs) should be preferred over arteriovenous grafts (AVGs) as first line for surgically placed accesses. The purpose of this study was to compare patency rates of surgical dialysis accesses in our mature, urban population after the FFBI. METHODS Current dialysis patients with accesses placed between 2006 and 2011 were included. Patient characteristics, access outcomes, interventions, and survival outcomes were analyzed. RESULTS We report outcomes of 220 patients undergoing dialysis access. Of those 220, 75 received numerous accesses. All outcomes are evaluated as per access itself, that is, a patient may have numerous access types, each individually analyzed. Of the accesses, 138 were AVF and 190 were AVG. The average age of patients was 59.8 years. The groups were evenly matched in distribution of race and prevalence of hypertension, diabetes, coronary artery disease, and Peripheral Vascular Disease (PVD). Average number of complications requiring intervention per access were fewer with AVF than AVG (1.21 vs 1.72, P = .02). The AVF had greater rates of stenosis (51.4% vs 40.6%, P = .0182), whereas AVG had greater thrombosis rates (14.6% vs 31.9%, P < .001). Both AVF and AVG had similar primary patency (median: 186 vs 142 days, P = .1774) and 3-year secondary patency (59.2% vs 49.2%, P = .0945). Arteriovenous fistula in patients aged <60 years was found to have the greatest primary ( P = .0078) and secondary patency ( P = .0400). Outcomes did not differ between AVF and AVG in those aged >60 years. CONCLUSIONS Although complications requiring intervention are greater with AVG, primary and secondary patency rates are similar between AVF and AVG, except when considering AVF in patients aged <60 years.
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Affiliation(s)
- Jacques Greenberg
- 1 Division of Vascular and Endovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Senthil Jayarajan
- 2 Section of Vascular Surgery, Washington University School of Medicine, MO, USA
| | - Sridhar Reddy
- 3 Division of Nephrology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Frank A Schmieder
- 1 Division of Vascular and Endovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Andrew B Roberts
- 1 Division of Vascular and Endovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Paul S van Bemmelen
- 1 Division of Vascular and Endovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jean Lee
- 3 Division of Nephrology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Eric T Choi
- 1 Division of Vascular and Endovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Mousa AY, Patterson W, Abu-Halimah S, Hass SM, Alhalbouni S, Sadek BT, Nanjundappa A, Modak A, Stone PA, Emmett M, AbuRahma AF. Patency in Arteriovenous Grafts in Hemodialysis Patients. Vasc Endovascular Surg 2013; 47:438-43. [PMID: 23853221 DOI: 10.1177/1538574413493678] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: It is difficult to maintain a working access for patients on hemodialysis. Despite current Dialysis Outcome Quality Initiatives recommendations of “Fistula First,” not everyone qualifies for a fistula, and those patients undergoing the alternative treatment, a graft, can experience graft failure. This study examines factors associated with arteriovenous graft (AVG) patency. Methods: A retrospective analysis was completed for all the patients who had an AVG during 2005 to 2010. Data were collected from electronic medical records, including date of first and subsequent interventions, salvage technique (surgical vs percutaneous), medical comorbidities, and use of antiplatelet medications (aspirin and clopidogrel). Continuous variables were compared with 2 sample t tests, and categorical variables with chi-square/Fisher exact test. Logistic regression was used to determine the odds ratio for risk factors associated with patency. A P value of <.05 was considered significant. All analyses were done using SAS 9.2 (SAS Institute Inc, Cary, North Carolina). Results: A total of 193 unique patients had an AVG. Of the 193 patients, 64% were female, 83% were hypertensive, and 64% were diabetic. The locations of the grafts were 80% arm, 15% forearm, and 5% thigh. Configurations, including loop and straight, were 34% and 63%, respectively. Comorbidities were not associated with patency. Primary patency was not found to be different with respect to location and configuration of graft and type of intervention. Primary patency for patients taking only aspirin (n = 43) and only clopidogrel (n = 17) were significantly different from patients on a combination of aspirin and clopidogrel (n = 7), with a P = .0051 and P = .0447, respectively. Conclusion: Neither location nor configuration affects the primary patency of AVGs. Aspirin alone is not inferior to aspirin and clopidogrel. Further prospective studies may be warranted to establish a consensus regarding medications and patency with AVGs.
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Affiliation(s)
- Albeir Y. Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | | | - Shadi Abu-Halimah
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Stephen M. Hass
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Saadi Alhalbouni
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Betro T. Sadek
- CAMC Health Education and Research Institute, Charleston, WV, USA
| | - Aravinda Nanjundappa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Asmita Modak
- CAMC Health Education and Research Institute, Charleston, WV, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick A. Stone
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Mary Emmett
- CAMC Health Education and Research Institute, Charleston, WV, USA
| | - Ali F. AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
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