The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts

Alik Farber; Tze-Woei Tan; Bo Hu; Laura M Dember; Gerald J Beck; Bradley S Dixon; John W Kusek; Harold I Feldman; Dialysis Access Consortium (DAC) Study Group

doi:10.1016/j.jvs.2015.06.132

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The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts

Journal article

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Peer reviewed

The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts

Alik Farber, Tze-Woei Tan, Bo Hu, Laura M Dember, Gerald J Beck, Bradley S Dixon, John W Kusek, Harold I Feldman and Dialysis Access Consortium (DAC) Study Group

Journal of vascular surgery, Vol.62(5), pp.1258-1265

11/2015

DOI: 10.1016/j.jvs.2015.06.132

PMID: 26254823

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Abstract

The arteriovenous graft (AVG) is most often used in hemodialysis patients when an autogenous fistula is not feasible. The optimal location (forearm or upper arm) and configuration (loop or straight) of AVGs are not known. To evaluate relationships of AVG location and configuration with patency, we conducted a secondary analysis using data from a randomized, placebo-controlled trial of dipyridamole plus aspirin for newly placed AVG. Participants of the Dialysis Access Consortium (DAC) Graft Study with newly placed upper extremity prosthetic grafts involving the brachial artery were studied. Multivariable analyses adjusting for trial treatment group, center, gender, race, body mass index, diabetes, current treatment with chronic dialysis, and prior arteriovenous vascular access or central venous catheter were performed to compare outcomes of forearm (fAVG) and upper arm (uAVG) grafts, including loss of primary unassisted patency (LPUP) and cumulative primary graft failure (CGF). Subgroup analyses of graft configuration and outflow vein used were also conducted. A total of 508 of the 649 participants (78%) enrolled in the trial had an upper extremity brachial artery graft placed, 255 with fAVG and 253 with uAVG. Participants with fAVG were less often male (33% vs 43%; P = .03), African American (62% vs 78%; P < .001), and receiving dialysis at the time of surgery (62% vs 80%; P < .001). Participants with fAVG had a higher mean body mass index (33 vs 29; P < .001). The LPUP (fAVG 70% vs uAVG 78%; P = .07) and CGF (33% vs 36%; P = .91) were similar between fAVG and uAVG at 1-year follow-up. In multivariable analysis, AVG location (uAVG vs fAVG) was not associated with LPUP (hazard ratio, 1.21; 95% confidence interval, 0.90-1.63; P = .20) or CGF (hazard ratio, 1.36; 95% confidence interval, 0.94-1.97; P = .10). LPUP did not differ significantly between fAVG and uAVG among subgroups based on AVG configuration (P = 1.00) or outflow vein used (P = .16). Patency was comparable between fAVG and uAVG despite the larger caliber veins often encountered in the upper arm in carefully selected patients. Our findings support the traditional view that, in order to preserve a maximal number of access sites, the forearm location should be considered first before resorting to an upper arm graft.

Multivariate Analysis

United States

Brachial Artery - surgery

Humans

Middle Aged

Male

Veins - surgery

Prosthesis Failure

Blood Vessel Prosthesis Implantation - adverse effects

Time Factors

Forearm - blood supply

Brachial Artery - physiopathology

Female

Retrospective Studies

Arteriovenous Shunt, Surgical - methods

Risk Factors

Kaplan-Meier Estimate

Proportional Hazards Models

Treatment Outcome

Chi-Square Distribution

Randomized Controlled Trials as Topic

Graft Occlusion, Vascular - etiology

Veins - physiopathology

Arteriovenous Shunt, Surgical - adverse effects

Aged

Graft Occlusion, Vascular - physiopathology

Renal Dialysis

Vascular Patency

Details

Title: Subtitle: The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts
Creators: Alik Farber - Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass. Electronic address: alik.farber@bmc.org
Tze-Woei Tan - Division of Vascular Surgery, Louisiana State University Shreveport Health Sciences Center, Shreveport, La
Bo Hu - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
Laura M Dember - Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
Gerald J Beck - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
Bradley S Dixon - Section of Nephrology, University of Iowa, Iowa City, Iowa
John W Kusek - National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
Harold I Feldman - Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
Dialysis Access Consortium (DAC) Study Group
Resource Type: Journal article
Publication Details: Journal of vascular surgery, Vol.62(5), pp.1258-1265
DOI: 10.1016/j.jvs.2015.06.132
PMID: 26254823
ISSN: 0741-5214
eISSN: 1097-6809
Grant note: U01 DK058986 / NIDDK NIH HHS
Language: English
Date published: 11/2015
Academic Unit: Anatomy and Cell Biology; Nephrology; Internal Medicine
Record Identifier: 9984094543502771

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