Outcomes of arteriovenous fistulae compared with heparin-bonded and conventional grafts for hemodialysis access

Purpose: Arteriovenous fistulae (AVF) are the preferred vascular access for hemodialysis patients. However, patients who do not have suitable veins require prosthetic arteriovenous graft (AVG) placement. We analyzed the patency and complication rates of upper extremity brachiocephalic AVF compared to brachioaxillary tapered heparin-bonded AVG and conventional AVG. Methods: We performed a retrospective analysis of patients who underwent a permanent vascular access procedure at our tertiary referral center from 2006 to 2008. Factors presumed to affect patency and complication rates including age, body-mass index, dyslipidemia, hypertension, and diabetes were analyzed. Complication rates, re-interventions, primary, primary-assisted, and cumulative patency rates were compared using logistic regression analysis. Results: We performed 138 upper extremity access procedures during the study period, including 64 brachiocephalic fistulae, 21 brachioaxillary heparin-bonded, and 21 brachioaxillary conventional AVGs. Nine patients were excluded from long-term follow-up. The 1-year cumulative patency rates for AVF, heparin-bonded, and conventional AVGs were 83%, 44%, and 67%, respectively (P = .0001). On multivariate regression analysis, only use of heparin- bonded AVG affected cumulative patency. Conclusions: Although selection bias cannot be excluded in this retrospective study, heparin- bonded AVGs did not perform better than conventional AVGs. Co-morbid conditions did not affect the cumulative patency or complication rates of brachiocephalic AVF or AVG in this analysis. Larger, randomized trials are needed to validate the results of this study.