Document Detail


Long-term outcomes of arteriovenous thigh grafts in hemodialysis patients: a comparison with tunneled dialysis catheters.
MedLine Citation:
PMID:  23371958     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Arteriovenous thigh grafts are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites. This study compared the outcomes of thigh grafts with outcomes obtained with dialysis catheters.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective vascular access database was queried to identify 209 thigh grafts placed from January 1, 2003, to June 30, 2011. The following were calculated: secondary graft survival (from graft creation to permanent failure), assisted primary graft survival (from graft creation to first thrombosis), and infection-free graft survival (from graft creation to first graft infection). Graft outcomes were compared with those observed with 472 tunneled internal jugular dialysis catheters.
RESULTS: The median duration of patient follow-up was 340 days for grafts and 91 days for catheters. The surgical technical failure rate of thigh grafts was 8.1% and was higher in patients with vascular disease (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.07-8.04; P=0.03). Secondary and assisted primary graft survival rates at 1, 2, and 5 years were 62%, 54%, and 38% and 38%, 27%, and 17%, respectively. Infection-free graft survival rates at 1, 2, and 5 years were 79%, 73%, and 61%. Secondary survival was much worse for dialysis catheters than thigh grafts (HR, 4.44; 95% CI, 3.65-5.22; P<0.001). Likewise, infection-free survival was far worse for catheters than for thigh grafts (HR, 3.77; 95% CI, 2.80-4.82; P<0.001).
CONCLUSIONS: Thigh grafts are a viable vascular option in patients who have exhausted upper-extremity options. Outcomes with thigh grafts are superior to those obtained with dialysis catheters.
Authors:
Song Ong; Jill Barker-Finkel; Michael Allon
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2013-01-31
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  8     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-08     Completed Date:  2013-12-16     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  804-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteriovenous Shunt, Surgical / adverse effects,  instrumentation
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation
Catheterization, Central Venous / adverse effects,  instrumentation*
Catheters, Indwelling*
Central Venous Catheters*
Equipment Design
Female
Graft Occlusion, Vascular / etiology
Humans
Jugular Veins*
Kaplan-Meier Estimate
Male
Middle Aged
Prosthesis-Related Infections / etiology
Renal Dialysis*
Risk Factors
Thigh / blood supply*
Thrombosis / etiology
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Clin J Am Soc Nephrol. 2013 May;8(5):708-10   [PMID:  23599407 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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