Bram M Voorzaat1, Cynthia J Janmaat2, Koen E A van der Bogt3,4, Friedo W Dekker2, Joris I Rotmans1. 1. Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. 2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
Abstract
Background: Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVGs). We aimed to investigate vascular access (VA) outcomes and assessed if AVF nonmaturation outweighs long-term complications of AVGs. Methods: In this multicenter, retrospective cohort study in The Netherlands, 1- and 3-year primary, primary assisted, secondary, and functional patency rates 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: In total, 1041 patients who received their first VA were included, of whom 863 had VAs that successfully matured. These patients were analyzed with a median follow-up of 25 months. The 1-year functional patency rates were 67%±2.0% for RCAVFs, 83%±2.0% for upper arm AVFs, and 85%±3.5% for AVGs. Three-year functional patency rates were 62%±2.0% for RCAVFs, 74%±2.0% for upper arm AVFs, and 69%±5% for AVGs. AVGs required more procedures per year (3.3 per year) of functional patency when compared with upper arm AVFs (1.8 per year). Conclusions: The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for HD. 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.
Background: Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVGs). We aimed to investigate vascular access (VA) outcomes and assessed if AVF nonmaturation outweighs long-term complications of AVGs. Methods: In this multicenter, retrospective cohort study in The Netherlands, 1- and 3-year primary, primary assisted, secondary, and functional patency rates 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: In total, 1041 patients who received their first VA were included, of whom 863 had VAs that successfully matured. These patients were analyzed with a median follow-up of 25 months. The 1-year functional patency rates were 67%±2.0% for RCAVFs, 83%±2.0% for upper arm AVFs, and 85%±3.5% for AVGs. Three-year functional patency rates were 62%±2.0% for RCAVFs, 74%±2.0% for upper arm AVFs, and 69%±5% for AVGs. AVGs required more procedures per year (3.3 per year) of functional patency when compared with upper arm AVFs (1.8 per year). Conclusions: The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for HD. 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.
Authors: Jan Tordoir; Bernard Canaud; Patrick Haage; Klaus Konner; Ali Basci; Denis Fouque; Jeroen Kooman; Alejandro Martin-Malo; Luciano Pedrini; Francesco Pizzarelli; James Tattersall; Marianne Vennegoor; Christoph Wanner; Piet ter Wee; Raymond Vanholder Journal: Nephrol Dial Transplant Date: 2007-05 Impact factor: 5.992
Authors: Jan Malik; Jaroslav Kudlicka; Ludmila Novakova; Josef Adamec; Hana Malikova; Jan Kavan Journal: J Vasc Access Date: 2014-04-17 Impact factor: 2.283
Authors: Tonia C Rothuizen; Chunyu Wong; Paul H A Quax; Anton Jan van Zonneveld; Ton J Rabelink; Joris I Rotmans Journal: Nephrol Dial Transplant Date: 2013-03-29 Impact factor: 5.992
Authors: Ronald L Pisoni; Eric W Young; Dawn M Dykstra; Roger N Greenwood; Erwin Hecking; Brenda Gillespie; Robert A Wolfe; David A Goodkin; Philip J Held Journal: Kidney Int Date: 2002-01 Impact factor: 10.612
Authors: Anton N Sidawy; Richard Gray; Anatole Besarab; Mitchell Henry; Enrico Ascher; Michael Silva; Arnold Miller; Larry Scher; Scott Trerotola; Roger T Gregory; Robert B Rutherford; K Craig Kent Journal: J Vasc Surg Date: 2002-03 Impact factor: 4.268
Authors: Louise M Moist; Charmaine E Lok; Tushar J Vachharajani; Wang Xi; Ahmed AlJaishi; Kevan R Polkinghorne; Miguel Vazquez; Timmy C Lee Journal: Semin Dial Date: 2012 Nov-Dec Impact factor: 3.455
Authors: Bram M Voorzaat; Koen E A van der Bogt; Cynthia J Janmaat; Jan van Schaik; Friedo W Dekker; Joris I Rotmans Journal: World J Surg Date: 2018-06 Impact factor: 3.352
Authors: Sara Cappelletti; Alessandro Caimi; Alice Caldiroli; Irene Baroni; Emiliano Votta; Stefania A Riboldi; Massimiliano M Marrocco-Trischitta; Alberto Redaelli; Francesco Sturla Journal: Quant Imaging Med Surg Date: 2022-07
Authors: Suzanne L Laboyrie; Margreet R de Vries; Alwin de Jong; Hetty C de Boer; Reshma A Lalai; Laisel Martinez; Roberto I Vazquez-Padron; Joris I Rotmans Journal: J Am Heart Assoc Date: 2022-08-05 Impact factor: 6.106