Arteriovenous graft patency outcomes and prognostic factors

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Jeeeun Park ◽  
Jinhae Kim ◽  
Subin Hwang ◽  
Mi Kyoung Lee ◽  
Hye Ryoun Jang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Prognostic Factors ◽  
Serum Albumin ◽  
Diastolic Blood Pressure ◽  
Laboratory Data ◽  
Graft Patency ◽  
Primary Patency ◽  
Hemoglobin Level ◽  
Secondary Patency ◽  
Arteriovenous Graft

Objectives Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes. Methods We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded. Outcomes included primary and secondary patency. Survival analysis was conducted using the Kaplan-Meier method; univariate and multivariate analyses were used to evaluate the prognostic factors. Results Data from 225 grafts were analyzed. During the follow-up period (mean: 583 days, range: 1–1717 days), 138 (61%) grafts required intervention and 46 (20%) permanently failed. Primary patency at one, two, and three years was 42%, 20%, and 16%, respectively. Secondary patency at one, two, and three years was 85%, 72%, and 64%, respectively. Multivariate analysis showed that primary patency was negatively associated with increasing age and location of vessel anastomosis (reference-brachiobrachial anastomosis; brachiobasilic – HR, 0.569; 95% CI, 0.376–0.860; p = 0.007; brachioaxillary anastomosis – HR 0.407; 95% CI, 0.263–0.631; p < 0.0001); secondary patency was positively associated with diastolic blood pressure, serum albumin level, and hemoglobin over 10 g/dL. Adverse events other than stenosis or thrombosis, such as infection/inflammation or pseudoaneurysm were observed in approximately 20% of grafts. Conclusions Factors associated with diminished primary arteriovenous graft patency included increased patient age and location of vessel anastomosis (brachiobrachial type compared to brachiobasilic or brachioaxillary type); diminished secondary patency was associated with low diastolic blood pressure, low serum albumin, and hemoglobin level under 10 g/dL. Among these factors, diastolic blood pressure, serum albumin, and hemoglobin level may be modifiable and could improve arteriovenous graft patency outcomes.

Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

2021 ◽  
pp. 112972982110150
Author(s):  
Jeremy Liu ◽  
Josiah Situmeang ◽  
Devin Takahashi ◽  
Russell Harada
Keyword(s):  
Primary Patency ◽  
The Body ◽  
Secondary Patency ◽  
Close Monitoring ◽  
Arteriovenous Graft ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Brachial Vein ◽  
Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

scholarly journals Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience

Perfusion ◽  
2021 ◽  
pp. 026765912199576
Author(s):  
Pasha Normahani ◽  
Ismail Yusuf Anwar ◽  
Alona Courtney ◽  
Amish Acharya ◽  
Viknesh Sounderajah ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Patency Rate ◽  
Bypass Graft ◽  
Graft Patency ◽  
Primary Patency ◽  
Rank Test ◽  
Secondary Patency ◽  
Factors Associated ◽  
Independent Variables ◽  
Secondary Patency Rate

Introduction: The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service. Methods: A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary’s Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging. Results: Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% ( n = 49/77) and the secondary patency rate was 67.5% ( n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04–5.7), p = 0.04). Conclusion: At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.

Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis

2020 ◽  
pp. 153857442096925
Author(s):  
Chen-Ting Cheng ◽  
Yuan-Chen Chang ◽  
Ka-Wai Tam ◽  
Yu-Chun Yen ◽  
Yu-Chen Ko
Keyword(s):  
Retrospective Study ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Basilic Vein ◽  
Arteriovenous Access ◽  
Secondary Outcomes

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.

Vacuum-assisted mechanical thrombectomy in extensively occlusive thrombosis of dialysis arteriovenous grafts with indigo system

2020 ◽  
Vol 21 (5) ◽  
pp. 673-679
Author(s):  
Filippo Piacentino ◽  
Andrea Coppola ◽  
Andrea Zaghetto ◽  
Edoardo Macchi ◽  
Giuseppe De Marchi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Primary Patency ◽  
Secondary Patency ◽  
Technical Failure ◽  
Arteriovenous Graft ◽  
Venous Outflow ◽  
Percutaneous Mechanical Thrombectomy ◽  
Arterial Inflow ◽  
Surgical Thrombectomy

Purpose: To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra’s Indigo System. Materials and Methods: Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15–45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. Results: Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). Conclusion: Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.

Forearm versus upper arm grafts for vascular access

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S77-S81
Author(s):  
Shawn M. Gage ◽  
Jeffrey H. Lawson
Keyword(s):  
Clinical Success ◽  
Ulnar Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Potential Complication ◽  
Upper Arm ◽  
Operative Planning ◽  
Arteriovenous Grafts ◽  
Steal Syndrome

Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.

scholarly journals Cardiovascular prevention using WhatsApp, project "Family Health: Connected and Healthy"

2021 ◽  
Vol 9 (2) ◽  
pp. 154-163
Author(s):  
Cristiano Jose Mendes Pinto ◽  
Fanuel Pedro de Puiz ◽  
Silvia Maria Ribeiro Oyama ◽  
Alberto Afonso Junior ◽  
Bruno Caramelli
Keyword(s):  
Blood Pressure ◽  
Public Schools ◽  
Diastolic Blood Pressure ◽  
Healthy Lifestyle ◽  
Laboratory Data ◽  
Family Health ◽  
Cardiovascular Prevention ◽  
Hdl Cholesterol ◽  
Prevention Education ◽  
Study Results

Objective: to analyze whether an educational program for cardiovascular prevention using WhatsApp can contribute to reducing Framingham risk score (FRS) among adults. Method: this is an intervention study, developed during one year (October/2019 to October/2020) in three public schools in São Paulo, among fathers, mothers, and family members of children enrolled in elementary school. Parents were invited to participate in the study by means of a note sent in the school agenda, and after signing the consent form, the participants received a weekly message from the researchers by WhatsApp, with guidelines to avoid sedentarism and maintain healthy lifestyle habits. Clinical and laboratory data were collected at the beginning and end of the study. Results: the study subjects were 70 adults, age 43.2 (±12 years), 47 females and 23 males. At the beginning of the study there were 09 (12.9%) parents with intermediate or high FRS, and at the end of the study there were 08 (11.4%) parents with intermediate or high FRS (p=0.79). A reduction in diastolic blood pressure was observed, mean from 80.3 mmHg to 77.7 mmHg (p=0.03; ±9.44), other three risk factors showed worsening in the outcome at the end of the study: HDL-cholesterol reduced mean from 55.9 mg/dL to 48.7 mg/dL (p=0.01), blood glucose increased from 91.4 mg/dL to 94.4 mg/dL (p=0.01) and body mass index was from 28.6 to 29.2 (p=0.01). Conclusion: The cardiovascular prevention education program using WhatsApp did not promote a reduction in FRS, and diastolic blood pressure was the only risk factor that responded to the intervention.

scholarly journals Arteriovenous graft patency outcomes and prognostic factors: A single-center study

2020 ◽  
Vol 7 (3) ◽  
pp. 222
Author(s):  
RanjithKumar Anandasu ◽  
RajendraPrasad Basavanthappa ◽  
AshwiniNaveen Gangadharan ◽  
Luv Luthra ◽  
JP Vivek Vardhan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Graft Patency ◽  
Arteriovenous Graft ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

scholarly journals NO Synthesis Markers Are Not Significantly Associated with Blood Pressure and Endothelial Dysfunction in Patients with Arterial Hypertension: A Cross-Sectional Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3895
Author(s):  
Oliver Malle ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Andreas Meinitzer ◽  
Martin H. Keppel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Endothelial Dysfunction ◽  
Arterial Hypertension ◽  
Diastolic Blood Pressure ◽  
Laboratory Data ◽  
Multivariate Regression Analysis ◽  
Cross Sectional Study ◽  
Symmetric Dimethylarginine ◽  
Cross Sectional ◽  
The Mean

Nitric oxide (NO) synthesis markers, comprising L-homoarginine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), are significantly associated with cardiovascular events and mortality. Being involved in NO pathways, they may be of high importance regulating vascular tone and arterial hypertension, but data on this topic are sparse and controversial. In this study, we evaluated whether these NO synthesis markers are associated with blood pressure values and pulse wave velocity (PWV). This analysis was based on the data of the Styrian Vitamin D Hypertension Trial, which included adults with arterial hypertension. We analyzed correlations of NO synthesis markers with 24 h ambulatory blood pressure values and PWV (primary outcomes), as well as with anthropometric and laboratory data. A total of 509 patients were included in the present analysis. The mean age was 61.2 ± 10.5 years, mean PWV was 8.6 ± 2.4 m/s, mean 24 h systolic blood pressure was 127.5 ± 13.8 mmHg and mean 24 h diastolic blood pressure was 76.4 ± 9.5 mmHg. In bivariate analyses, there was a significant positive correlation between homoarginine and 24 h diastolic blood pressure (r = 0.1; p = 0.02), which was revealed to be no longer significant after adjustment for age, gender and glomerular filtration rate (GFR) in multivariate regression analysis. No other significant correlations of any NO synthesis markers with blood pressure or PWV were observed. In line with previous studies, there were inverse associations between homoarginine and age and between ADMA or SDMA and GFR (p < 0.05 for all). This study did not reveal a significant association between homoarginine, ADMA or SDMA and blood pressure or PWV in hypertensive adults. These results suggested that the associations of these parameters with adverse outcome may not be mediated by hypertension and/or endothelial dysfunction.

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