Upper arm arteriovenous fistula versus forearm looped arteriovenous graft for hemodialysis access: A comparative analysis

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

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

If an autogenous wrist radiocephalic arteriovenous fistula cannot be created, the next choice for chronic hemodialysis access may be a prosthetic forearm looped arteriovenous graft (FAL-AVG) or a native upper arm arteriovenous fistula (UA-AVF). We reviewed our experience with these two forms of dialysis access to determine which is preferable. Patient medical records were retrospectively reviewed. The main outcomes were time to first use, complications, and reinterventions as well as primary and assisted primary patency. Eighty-six patients underwent creation of UA-AVF, and 60 patients underwent placement of FAL-AVG. Time to first use was 3.8 months for UA-AVFs vs. 1.8 months for FAL-AVGs (p < 0.018). Complication rates were 42% vs. 65% for UA-AVFs vs. FAL-AVGs, respectively (p = 0.006). Thrombosis was more common in FAL-AVGs than UA-AVFs (42% vs. 17%, p = 0.001), as was nonelective reintervention (50% vs. 30%, p = 0.016). Patency rates were similar at 1 and 2 years. Although UA-AVFs and FAL-AVGs share similar early patency rates, UA-AVFs may be a better choice for chronic hemodialysis access because of a lower incidence of complications and nonelective reinterventions. To maximize the benefits of UA-AVFs, however, early surgical referral is required.

Original languageEnglish (US)
Pages (from-to)843-850
Number of pages8
JournalAnnals of Vascular Surgery
Volume19
Issue number6
DOIs
StatePublished - Nov 2005

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Arteriovenous Fistula
Forearm
Renal Dialysis
Arm
Transplants
Wrist
Medical Records
Dialysis
Thrombosis
Referral and Consultation
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Upper arm arteriovenous fistula versus forearm looped arteriovenous graft for hemodialysis access: A comparative analysis",
abstract = "If an autogenous wrist radiocephalic arteriovenous fistula cannot be created, the next choice for chronic hemodialysis access may be a prosthetic forearm looped arteriovenous graft (FAL-AVG) or a native upper arm arteriovenous fistula (UA-AVF). We reviewed our experience with these two forms of dialysis access to determine which is preferable. Patient medical records were retrospectively reviewed. The main outcomes were time to first use, complications, and reinterventions as well as primary and assisted primary patency. Eighty-six patients underwent creation of UA-AVF, and 60 patients underwent placement of FAL-AVG. Time to first use was 3.8 months for UA-AVFs vs. 1.8 months for FAL-AVGs (p < 0.018). Complication rates were 42{\%} vs. 65{\%} for UA-AVFs vs. FAL-AVGs, respectively (p = 0.006). Thrombosis was more common in FAL-AVGs than UA-AVFs (42{\%} vs. 17{\%}, p = 0.001), as was nonelective reintervention (50{\%} vs. 30{\%}, p = 0.016). Patency rates were similar at 1 and 2 years. Although UA-AVFs and FAL-AVGs share similar early patency rates, UA-AVFs may be a better choice for chronic hemodialysis access because of a lower incidence of complications and nonelective reinterventions. To maximize the benefits of UA-AVFs, however, early surgical referral is required.",
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AU - Chin, Andrew I

AU - Perez, Richard V

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