514 - Comparative Analysis Between Percutaneous and Surgically-Created Arteriovenous Fistulas for Hemodialysis

Purpose: Arteriovenous fistulas (AVF) are the first-line sites for hemodialysis access in patients suffering from end-stage renal disease (ESRD). Patient prognosis largely depends on the patency of these fistulas. Historically, AVFs were surgically created but were associated with increased risk of failure and distal AVF ischemia (steal syndrome). The advent of percutaneous devices has allowed for minimally-invasive opportunities in creating AVFs, but there remains controversy regarding their efficacy.

Materials and Methods: TriNetX was used to evaluate patient electronic medical records between January 1st, 2020 and September 1st, 2024. Patients receiving a first time surgically (sAVF) or percutaneously (pAVF) created AVF and were diagnosed with ESRD were included in our study. Patients who received an AV graft were excluded from the study. Patients were split into two cohorts based on the type of AVF. Patients were 1-to-1 propensity matched with a history of diabetes, hypertension, and previous hemodialysis access. Final totals were 250 patients in each cohort. Primary outcome measured was rates of steal syndrome at 3, 6, 12, and 24 months. Primary and cumulative patency were measured at 12 and 24 months. Other secondary outcomes measured were rates of percutaneous and open surgical reinterventions at 3, 6, 12, and 24 months.

Results: pAVF was associated with greater rates of steal syndrome earlier on at 3 (RR = 2.308, 95% CI (1.233,4.319)) and 6 months (RR = 1.682, 95% CI (1.022,2.766)), but no significant difference was found afterwards. sAVF was consistently associated with greater rates of open surgical revisions than pAVF across all timepoints, while pAVF was associated with greater rates of percutaneous interventions at 3, 6, and 12 months. pAVF primary patency at 1 and 2 years was 68% and 65.6%, respectively, while sAVF primary patency at 1 and 2 years was 70.8% and 65.2%, respectively. No significant difference was found between 1 and 2 year primary patency (p = .496, p = .925). pAVF cumulative patency at 1 and 2 years was 80% and 78.8%, respectively, while sAVF primary patency at 1 and 2 years was 79.6% and 76.8%, respectively. No significant difference was found between 1 and 2 year cumulative patency (p = .911, p = .59).

Conclusion: pAVF achieves similar success in short and long-term patency when compared to sAVF with less risk of open surgical interventions and distal AVF ischemia. Further randomized-controlled studies are necessary in ascertaining pAVF’s efficacy.