Arteriovenous fistulae vs. arteriovenous grafts: A retrospective review of 1,700 consecutive vascular access cases

A. Frederick Schild, Eduardo Perez, E. Gillaspie, C. Seaver, J. Livingstone, A. Thibonnier

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Objective: Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called "Fistula First" to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles. Methods: A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented. Results: The study reviewed 1700 procedures. The median age was 52 (60.2% male) with 58.7% fistulae and 41.3% grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1%), lower arm (24.5%) and thigh (5.4%). Graft infection rate was 9.5% and fistula infection rate was 0.9% (p<0.001). The overall infection rate was 4.5%, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7% of grafts and 9.0% of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency. Conclusions: AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.

Original languageEnglish
Pages (from-to)231-235
Number of pages5
JournalJournal of Vascular Access
Volume9
Issue number4
StatePublished - Dec 1 2008

Fingerprint

Arteriovenous Fistula
Blood Vessels
Transplants
Fistula
Thrombosis
Arm
Infection
Thigh
Renal Dialysis
Demography
HIV
Morbidity

Keywords

  • Arterio-venous fistula (AVF)
  • Cox regression
  • Diabetes
  • Fistual first
  • Hypertension
  • Kaplan-Meyer
  • KDOQI guidelines
  • Log Rank Test
  • Non autogenous graft (AVG)
  • Scribner Shunt
  • Thrombosis
  • Vascular access

ASJC Scopus subject areas

  • Surgery
  • Nephrology

Cite this

Schild, A. F., Perez, E., Gillaspie, E., Seaver, C., Livingstone, J., & Thibonnier, A. (2008). Arteriovenous fistulae vs. arteriovenous grafts: A retrospective review of 1,700 consecutive vascular access cases. Journal of Vascular Access, 9(4), 231-235.

Arteriovenous fistulae vs. arteriovenous grafts : A retrospective review of 1,700 consecutive vascular access cases. / Schild, A. Frederick; Perez, Eduardo; Gillaspie, E.; Seaver, C.; Livingstone, J.; Thibonnier, A.

In: Journal of Vascular Access, Vol. 9, No. 4, 01.12.2008, p. 231-235.

Research output: Contribution to journalArticle

Schild, AF, Perez, E, Gillaspie, E, Seaver, C, Livingstone, J & Thibonnier, A 2008, 'Arteriovenous fistulae vs. arteriovenous grafts: A retrospective review of 1,700 consecutive vascular access cases', Journal of Vascular Access, vol. 9, no. 4, pp. 231-235.
Schild, A. Frederick ; Perez, Eduardo ; Gillaspie, E. ; Seaver, C. ; Livingstone, J. ; Thibonnier, A. / Arteriovenous fistulae vs. arteriovenous grafts : A retrospective review of 1,700 consecutive vascular access cases. In: Journal of Vascular Access. 2008 ; Vol. 9, No. 4. pp. 231-235.
@article{c1d9837516244a3ab4c5972721b33dde,
title = "Arteriovenous fistulae vs. arteriovenous grafts: A retrospective review of 1,700 consecutive vascular access cases",
abstract = "Objective: Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called {"}Fistula First{"} to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles. Methods: A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented. Results: The study reviewed 1700 procedures. The median age was 52 (60.2{\%} male) with 58.7{\%} fistulae and 41.3{\%} grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1{\%}), lower arm (24.5{\%}) and thigh (5.4{\%}). Graft infection rate was 9.5{\%} and fistula infection rate was 0.9{\%} (p<0.001). The overall infection rate was 4.5{\%}, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7{\%} of grafts and 9.0{\%} of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency. Conclusions: AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.",
keywords = "Arterio-venous fistula (AVF), Cox regression, Diabetes, Fistual first, Hypertension, Kaplan-Meyer, KDOQI guidelines, Log Rank Test, Non autogenous graft (AVG), Scribner Shunt, Thrombosis, Vascular access",
author = "Schild, {A. Frederick} and Eduardo Perez and E. Gillaspie and C. Seaver and J. Livingstone and A. Thibonnier",
year = "2008",
month = "12",
day = "1",
language = "English",
volume = "9",
pages = "231--235",
journal = "Journal of Vascular Access",
issn = "1129-7298",
publisher = "Wichtig Publishing",
number = "4",

}

TY - JOUR

T1 - Arteriovenous fistulae vs. arteriovenous grafts

T2 - A retrospective review of 1,700 consecutive vascular access cases

AU - Schild, A. Frederick

AU - Perez, Eduardo

AU - Gillaspie, E.

AU - Seaver, C.

AU - Livingstone, J.

AU - Thibonnier, A.

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Objective: Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called "Fistula First" to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles. Methods: A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented. Results: The study reviewed 1700 procedures. The median age was 52 (60.2% male) with 58.7% fistulae and 41.3% grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1%), lower arm (24.5%) and thigh (5.4%). Graft infection rate was 9.5% and fistula infection rate was 0.9% (p<0.001). The overall infection rate was 4.5%, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7% of grafts and 9.0% of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency. Conclusions: AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.

AB - Objective: Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called "Fistula First" to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles. Methods: A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented. Results: The study reviewed 1700 procedures. The median age was 52 (60.2% male) with 58.7% fistulae and 41.3% grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1%), lower arm (24.5%) and thigh (5.4%). Graft infection rate was 9.5% and fistula infection rate was 0.9% (p<0.001). The overall infection rate was 4.5%, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7% of grafts and 9.0% of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency. Conclusions: AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.

KW - Arterio-venous fistula (AVF)

KW - Cox regression

KW - Diabetes

KW - Fistual first

KW - Hypertension

KW - Kaplan-Meyer

KW - KDOQI guidelines

KW - Log Rank Test

KW - Non autogenous graft (AVG)

KW - Scribner Shunt

KW - Thrombosis

KW - Vascular access

UR - http://www.scopus.com/inward/record.url?scp=60549117189&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=60549117189&partnerID=8YFLogxK

M3 - Article

C2 - 19085891

AN - SCOPUS:60549117189

VL - 9

SP - 231

EP - 235

JO - Journal of Vascular Access

JF - Journal of Vascular Access

SN - 1129-7298

IS - 4

ER -