Park Jeeeun, Kim Jinhae, Hwang Subin, Lee Mi Kyoung, Jang Hye Ryoun, Eun Lee Jung, Park Yang-Jin, Huh Wooseong, Kim Yoon-Goo, Oh Ha Young, Joong Kim Dae
1 Division of Nephrology, Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Gangwon-do, South Korea.
2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Vascular. 2019 Apr;27(2):128-134. doi: 10.1177/1708538118807844. Epub 2018 Oct 26.
Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes.
We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded. Outcomes included primary and secondary patency. Survival analysis was conducted using the Kaplan-Meier method; univariate and multivariate analyses were used to evaluate the prognostic factors.
Data from 225 grafts were analyzed. During the follow-up period (mean: 583 days, range: 1-1717 days), 138 (61%) grafts required intervention and 46 (20%) permanently failed. Primary patency at one, two, and three years was 42%, 20%, and 16%, respectively. Secondary patency at one, two, and three years was 85%, 72%, and 64%, respectively. Multivariate analysis showed that primary patency was negatively associated with increasing age and location of vessel anastomosis (reference-brachiobrachial anastomosis; brachiobasilic - HR, 0.569; 95% CI, 0.376-0.860; p = 0.007; brachioaxillary anastomosis - HR 0.407; 95% CI, 0.263-0.631; p < 0.0001); secondary patency was positively associated with diastolic blood pressure, serum albumin level, and hemoglobin over 10 g/dL. Adverse events other than stenosis or thrombosis, such as infection/inflammation or pseudoaneurysm were observed in approximately 20% of grafts.
Factors associated with diminished primary arteriovenous graft patency included increased patient age and location of vessel anastomosis (brachiobrachial type compared to brachiobasilic or brachioaxillary type); diminished secondary patency was associated with low diastolic blood pressure, low serum albumin, and hemoglobin level under 10 g/dL. Among these factors, diastolic blood pressure, serum albumin, and hemoglobin level may be modifiable and could improve arteriovenous graft patency outcomes.
用于血液透析的动静脉移植物由于频繁出现狭窄和血栓形成，其治疗效果比动静脉内瘘差。我们研究了动静脉移植物的通畅结局以及这些结局的预后因素。
我们纳入了一个单中心队列，该队列中的患者在2010年至2014年期间接受了用于血液透析通路的动静脉移植物。从病历中收集人口统计学、实验室数据、合并症和用药情况。还记录了与移植物手术相关的手术因素，包括连接血管的类型和直径、移植物位置以及手术类型（择期或急诊）。结局包括初次通畅和二次通畅。使用Kaplan-Meier方法进行生存分析；采用单因素和多因素分析来评估预后因素。
分析了225个移植物的数据。在随访期间（平均：583天，范围：1 - 1717天），138个（61%）移植物需要干预，46个（20%）永久失功。1年、2年和3年的初次通畅率分别为42%、20%和16%。1年、2年和3年的二次通畅率分别为85%、72%和64%。多因素分析显示，初次通畅与年龄增加和血管吻合位置呈负相关（参照 - 肱 - 肱吻合；肱 - 尺侧腕屈肌吻合 - HR，0.569；95% CI，0.376 - 0.860；p = 0.007；肱 - 腋吻合 - HR 0.407；95% CI，0.263 - 0.631；p < 0.0001）；二次通畅与舒张压、血清白蛋白水平以及血红蛋白超过10 g/dL呈正相关。在大约20%的移植物中观察到了除狭窄或血栓形成之外的不良事件，如感染/炎症或假性动脉瘤。
与动静脉移植物初次通畅率降低相关的因素包括患者年龄增加和血管吻合位置（与肱 - 尺侧腕屈肌型或肱 - 腋型相比，肱 - 肱型）；二次通畅率降低与舒张压低、血清白蛋白低以及血红蛋白水平低于10 g/dL有关。在这些因素中，舒张压、血清白蛋白和血红蛋白水平可能是可改变的，并且可以改善动静脉移植物的通畅结局。
