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![Patency outcomes of arteriovenous fistulas and grafts for hemodialysis access: a trade-off between non-maturation and long-term complications](https://scholarlypublications.universiteitleiden.nl/sites/all/themes/scholarly/img/closed_access.png)
Patency outcomes of arteriovenous fistulas and grafts for hemodialysis access: a trade-off between non-maturation and long-term complications
INTRODUCTION: Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVG). We aimed to investigate vascular access (VA) outcomes and assessed if AVF non-maturation outweighs long-term complications of AVGs.
METHODS: In this multicenter retrospective cohort-study in the Netherlands, one- and three-year primary, primary assisted, secondary and functional patency were calculated and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs and AVGs was compared using Cox analyses.
RESULTS: 1041 patients who received their first VA were included of which 863 successfully matured. These patients were analyzed with a median follow-up of 25 months. The one-year functional patency was 67 ± 2.0% for RCAVFs, 83 ± 2.0% for upper arm AVFs, and 85 ± 3.5% for AVGs, respectively. Three-year functional patency was 62 ± 2.0% for RCAVFs, 74 ± 2.0% for upper arm AVFs, and 69...
Show moreINTRODUCTION: Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVG). We aimed to investigate vascular access (VA) outcomes and assessed if AVF non-maturation outweighs long-term complications of AVGs.
METHODS: In this multicenter retrospective cohort-study in the Netherlands, one- and three-year primary, primary assisted, secondary and functional patency were calculated and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs and AVGs was compared using Cox analyses.
RESULTS: 1041 patients who received their first VA were included of which 863 successfully matured. These patients were analyzed with a median follow-up of 25 months. The one-year functional patency was 67 ± 2.0% for RCAVFs, 83 ± 2.0% for upper arm AVFs, and 85 ± 3.5% for AVGs, respectively. Three-year functional patency was 62 ± 2.0% for RCAVFs, 74 ± 2.0% for upper arm AVFs, and 69 ± 5% for AVGs, respectively. AVGs required more procedures per year (3.3/year) of functional patency when compared to upper arm AVFs (1.8/year).
CONCLUSION: The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for hemodialysis. The choice of VA is a trade-off between short-term advantages, favoring AVGs and long-term advantages, favoring AVFs. Which VA is most appropriate depends on the patient’s prognosis and preferences.
Show less- All authors
- Voorzaat, B.M.; Janmaat, C.J.; Bogt, K.E.A. van der; Dekker, F.W.; Rotmans, J.I.
- Date
- 2020
- Journal
- Kidney 360