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

Sang Chul Yun; Dan Song; Chul Moon

doi:10.4174/jkss.2010.78.6.410

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

Original Article

Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 78(6): 410-418.

Published online: 7 June 2010

DOI: https://doi.org/10.4174/jkss.2010.78.6.410

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

Sang Chul Yun, M.D., Dan Song, M.D., Chul Moon, M.D.

Department of Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea.

Corresponding author (Moonc@hosp.sch.ac.kr)

Received 3 December 2009 Accepted 15 March 2010

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.

Keywords: Arteriovenous graft, Graft venous anastomosis stenosis

Figures and Tables

Fig. 1

Post-intervention primary patency (PIPP) of salvaged grafts calculated by Kaplan-Meier method, and compares 2 groups by log-rank test. PIPP of group B was significantly lower than group A (P=0.018).

Fig. 2

Post-intervention secondary patency of salvaged grafts were compared and not significantly different between 2 groups by log-rank test (P=0.359).

Fig. 3

Cause of early rethrombosis.

Fig. 4

Comparison of post-surgical patency rates between early rethrombosis group and group B.

Fig. 5

Comparison of post-surgical patency rates between curettage (n=32) and no curettage (n=70) in the failed graft (Group B).

Table 1

Comparison of demographics and characteristics

Data are reported as mean±standard deviation or percentage. ^*Group A = elective jump graft; ^†Group B = emergency open thrombectomy and jump graft; ^‡NS = not significant; ^§Graft age defined as the interval between access construction and salvage operation.; ^∥F/U = follow up.

Table 2

Post-operative access event

Table 3

Proportion of associated stenosis

^*GAA = graft-arterial anastomosis.

Table 4

Risk factors on post-intervention primary patency of salvaged grafts

^*Hazard ratio by Cox regression adjusted for male gender, hypertension, long op. time, salvage after thrombosis, midgraft curettage, abnormal postop. fistulogram, not doing fistulogram. In multivariate analysis, hypertension were associated with decreased risk, salvage after thrombosis, not doing fistulogram were associated with increased risk.

Table 5

Postoperative complications

^*Early rethrombosis = thrombosis within one month after operation.

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