J Korean Surg Soc.  2010 Jun;78(6):410-418. 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

• Yun SC
• Song D
• Moon C

• KMID: 2211973
• DOI: http://doi.org/10.4174/jkss.2010.78.6.410

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.

Keyword

Arteriovenous graft; Graft venous anastomosis stenosis

MeSH Terms

Constriction, Pathologic
Emergencies
Follow-Up Studies
Graft Survival
Polytetrafluoroethylene
Renal Dialysis
Thrombectomy
Thrombosis
Transplants
Polytetrafluoroethylene

Figure

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  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).

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  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).

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  Fig. 3 Cause of early rethrombosis.

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  Fig. 4 Comparison of post-surgical patency rates between early rethrombosis group and group B.

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  Fig. 5 Comparison of post-surgical patency rates between curettage (n=32) and no curettage (n=70) in the failed graft (Group B).

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