Upper Arm Arteriovenous Fistula Versus Forearm Looped Arteriovenous Graft for Hemodialysis Access: A Comparative Analysis

Fitzgerald, Jason T.; Schanzer, Andres; McVicar, John P.; Chin, Andrew I.; Perez, Richard V; Troppmann, Christoph

doi:10.1007/s10016-005-7419-y

Cited by 43 publications

(39 citation statements)

References 13 publications

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“…If a patient is predialysis, the patient will not require a tunneled catheter, and the practitioner may feel less urgency to create a functioning fistula/graft after the index fistula/ graft fails. Accordingly, we limited the study population to patients who were dialysis dependent at the time of index fistula/graft creation as other authors have done when comparing outcomes of fistulas and grafts (21)(22)(23)(24)(25)(26). Doing so helped to equalize the baseline risk of mortality associated with dialysis dependence and the baseline risk of requiring a repeat fistula/graft or catheter.…”

Section: Discussionmentioning

confidence: 99%

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Woo¹,

Goldman

Romley

2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent evidence indicates that fistula maturation and patency may be compromised in the elderly dialysis population compared with younger patients. The objective of this study was to characterize the short-term outcomes of arteriovenous fistulas and arteriovenous grafts for hemodialysis access in the Medicare population.Design, setting, participants, & measurements This was a retrospective cohort study performed using Medicare Part A and B claims data from 2006 through 2011. The study population included 16,464 dialysis-dependent patients age $66 years undergoing arteriovenous fistula and arteriovenous graft creation. The primary outcome measure was incidence of repeat fistula/graft creation and tunneled catheter placements in the 12 months after arteriovenous fistula and graft creation.Results In the 12 months postindex fistula/graft, the mortality in the fistula group was 28.2% versus 29.9% in the graft group (P=0.03). A repeat fistula/graft creation was required in 26.9% of patients in the fistula group and 16.7% in the graft group (P,0.001). There was no significant difference in the proportion of patients who required a tunneled hemodialysis catheter in the 12 months after an index fistula creation (fistula 28.4% versus graft 27.3%, P=0.19). In the index fistula group, 44.4% of patients required a repeat fistula/graft creation and/or a tunneled catheter, compared with 33.7% in the graft group (P,0.001). At 365 days after the index fistula/graft, the repeat fistula/graft/catheter-free survival was 39.7% in the fistula group versus 46.0% in the graft group (P,0.001). Index fistula was associated with a higher risk of loss of repeat fistula/graft/catheter-free survival with an odds ratio of 1.19 (95% confidence interval, 1.13 to 1.24).Conclusions Fistulas were associated with a somewhat lower mortality than grafts in the first 12 months after creation. However, the incidence of repeat fistula/graft creation and tunneled catheter placement is substantially higher in the first 12 months after fistula creation compared with grafts. One-year repeat fistula/graft/catheterfree survival is lower after fistula creation than grafts.

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Section: Discussionmentioning

confidence: 99%

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Woo¹,

Goldman

Romley

2015

Clinical Journal of the American Society of Nephrology

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“…[8][9][10] Arteriovenous fistulas have the superior primary patency rates, the lowest rates of thrombosis, and require the fewest secondary interventions. 6,[11][12][13] arteriovenous fistulas generally provide longer hemodialysis access survival rates. [13][14][15][16] The total number of interventions during the life of the access is considerably lower for arteriovenous fistulas compared with arteriovenous grafts.…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

et al. 2016

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Background: Chronic kidney disease (CKD) is a long term condition caused by damage to both kidneys. The benefits of arteriovenous fistulas over other forms of chronic access are: Arteriovenous fistulas are associated with decreased morbidity and mortality among hemodialysis patients compared with arteriovenous grafts and central venous catheters. Objectives of the study were o choose the proper sites for formation of arteriovenous fistula, to find out the success rate at various sites and to study the complications of arteriovenous fistula.Methods: This prospective study was carried out on total 150 patients over the duration of two years. The fistulae were created using radial artery and cephalic vein side to side (Radiocephalic AVF) and brachial artery and cephalic vein side to side anastomosis (Brachiocephalic AVF). Doppler studies were done before and after every procedure to demonstrate the velocity, volume of blood flow, depth from the skin, diameter of vessels and to access the time of maturation of AVF. Patients were followed up to first dialysis by AVF to assess the overall outcomes and various complications.Results: Brachiocephalic AVF matured earlier than Radiocephalic AVF (mean maturation time Brachiocephalic 38.02 days and Radiocephalic 43.26 days) which was statistically significant. Brachiocephalic AVF matured earlier than Radiocephalic AVF with more flow rate. Complication rate was more at wrist (Radiocephalic AVF with 66.67% of overall complication) than at elbow (Brachiocephalic AVF with 33.33% of overall complication).Conclusions: We concluded that the Brachiocephalic AVF maturation time was significantly less than the maturation time of Radiocephalic AVF and rate of complication was less in Brachiocephalic AVF. The utility of pre-operative colour Doppler to select the vessels for AVF creation was found to be as an essential parameter of pre-operative work up.

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“…It was only after 2 years that differences in patency became more pronounced and AVGs were more prone to late failure. In addition, this study and others did not find any differences in the rates of infectious complications (28). Thus, suitable patients for AVF placement should include those expected to have a reasonably good prognosis for survival as identified by age ,75 years or $75 years with low comorbidity scores, limited functional impairment, and reasonable nutritional status.…”

Section: Elderly Patients and Multiple Comorbiditiesmentioning

confidence: 52%

Re-envisioning Fistula First in a Patient-Centered Culture

Gomes

Schmidt

Wish

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe main options for vascular access in hemodialysis patients are arteriovenous fistulas (AVFs), arteriovenous grafts, and tunneled cuffed central venous catheters. AVFs have the lowest complication rate and require the fewest interventions and lowest cost to maintain. There has been a dramatic national increase in prevalent AVFs among patients with ESRD in the United States driven, in part, by the Fistula First Breakthrough Initiative. The Fistula First Breakthrough Initiative has engaged stakeholders in the dialysis community to disseminate best practices and quality improvement activities to increase AVF prevalence in suitable candidates. In the pursuit of maximizing AVF placement and prevalence, less emphasis has been placed on the individual patient context. An AVF may not be the best access choice in a subset of patients, particularly those with poor long-term prognoses or comorbid chronic diseases with a short life expectancy, those patients more likely to die than to have their CKD progress to ESRD requiring dialysis, and those with vascular anatomy not amenable to successful AVF placement. Placement of an AVF in these patients subjects them to uncomfortable and likely unnecessary and/or unsuccessful surgeries at an expense, while doing little to improve their clinical outcome or their individual experience of care. AVF prevalence as a pay-for-performance measure without the appropriate case-mix adjustment may penalize providers for accepting higher-risk patients. Although a functioning AVF that provides reliable hemodialysis remains the gold standard for vascular access for most patients, it may not be the most suitable option for every patient.

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Upper Arm Arteriovenous Fistula Versus Forearm Looped Arteriovenous Graft for Hemodialysis Access: A Comparative Analysis

Cited by 43 publications

References 13 publications

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

Re-envisioning Fistula First in a Patient-Centered Culture

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