Comparison of Post-surgical Patency Rates between Failing and Failed Arterio-venous Graft for Hemodialysis with Venous Anastomosis Stenosis

ABSTRACT

PURPOSE: The most frequent complication in vascular access for hemodialysis is the stenosis of venous anastomosis site and resultant thrombosis. And it has been suggested that the correction of stenosis before thrombosis can prolong graft survival. We compared the outcomes of surgical repair between stenosed group and thrombosed group. METHODS: From March 2003 to July 2007, 155 cases of stenosed graft-venous anastomosis (GVA) of arteriovenous graft (AVG) underwent salvage operation; 53 elective revisions for stenosis (group A), and 102 emergency open thrombectomies with jump grafts (group B). Outcomes were compared by post-intervention primary patency (PIPP) and post-intervention secondary patency (PISP). RESULTS: The mean follow-up duration was 24.8+/-15.2 months. Surgical success rate was 100% for elective revision group and 98% for emergency operation group. Elective revision of symptomatic GVA stenosis improved PIPP compared to emergency operation of thrombosed graft (mean 13.0 vs. 8.6 months, P=0.018). But PISP was not extended (mean 24.2 vs. 23.2 months, P=0.359). The electively revised GVA stenosed graft had fewer subsequent thrombotic events (0.3 vs 0.7 thrombosis/patient year, P=0.027) and fewer interventions (0.6 vs. 1.2 interventions/patient year, P=0.06). The proportion of other stenoses for group A and group B was 35.8% and 38.2%, respectively. CONCLUSION: The frequency of subsequent thrombotic events and total number of postoperative interventions decreased significantly after elective revision. Elective revision of GVA stenosis in PTFE graft prolongs PIPP, and should be considered before the occurrence of thrombosis.