SIR 2024
Renal and GU Interventions
Ramtin Talebi, BA
Medical Student
Sidney Kimmel Medical College
Financial relationships: Full list of relationships is listed on the CME information page.
Paul DiMuzio, MD
William M. Measey Professor of Surgery; Director, Division of Vascular Surgery
Sidney Kimmel Medical College
Disclosure information not submitted.
Babak Abai, MD
Associate Professor of Vascular Surgery
Sidney Kimmel Medical College
Disclosure information not submitted.
Dawn Salvatore, MD
Assistant Professor of Vascular Surgery
Sidney Kimmel Medical College
Disclosure information not submitted.
Michael Nooromid, MD
Assistant Professor of Vascular Surgery
Sidney Kimmel Medical College
Disclosure information not submitted.
Arteriovenous (AV) fistulas and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease (ESRD). However, complications and access failure often necessitate re-intervention, highlighting the need to understand the factors associated with decreased primary patency {1, 2, 3}.
Materials and Methods:
We analyzed data from electronic medical records of hemodialysis patients who underwent arteriovenous (AV) fistula creation between 2012 and 2023. The study population consisted of 119 patients. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted. Survival analysis was conducted to determine revision timing in AV fistulas, with hazard ratios calculated to identify independent predictors of shorter times to revision (i.e. decreased primary patency).
Results:
A total of 119 patients were included in the study, with mean age of 55.2 years and mean body mass index (BMI) of 28.1. The majority of patients were male (57%) and Black (63%). Hypertension (44%) and diabetes (29%) were the leading causes of ESRD. Operative history revealed 41% of patients had prior central venous catheter (CVC) placement and 15% had a prior AV fistula. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%).
The most common indications for revision were steal syndrome (29%) and pseudoaneurysm (24%). Univariate survival analysis identified age and prior CVC placement as significant predictors of need for revision. Multivariate survival analysis confirmed these findings (Table 1); age and previous CVC placement remained significant after adjusting for potential confounders (hypertension, gender, diabetes, statin use). Patients with prior CVC placement had a 77% increased risk of earlier revision.
Conclusion:
In conclusion, this study sheds light on the factors associated with revision timing in permanent hemodialysis access. Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies {4, 5, 6}. Age and prior CVC placement emerged as independent predictors of earlier revision, emphasizing the importance of considering these factors in the management and follow-up of patients.