Outcomes of Arteriovenous Fistula and Arteriovenous Graft in Patients on Maintenance Haemodialysis in a Tertiary Care Centre OC05-OC08
Dr. Elayaperumal Indhumathi,
E 19, Staff Quarters, Sri Ramachandra Medical College, Porur, Chennai-600116, Tamil Nadu, India.
Introduction: Arterio-Venous (AV) fistula is the preferred choice of vascular access in all haemodialysis patients but AV graft may be an alternate option in selective patients.
Aim: To compare and evaluate the primary and cumulative patency of patients with AV Fistula (AVF) and AV Graft (AVG) undergoing maintenance haemodialysis.
Materials and Methods: This was a retrospective study of the data of 32 patients with AVG and 63 patients with AVF between November 2013 and December 2018. Primary survival and cumulative patency between AVF and AVG were compared using Kaplan Meier survival curves and Log Rank tests. Sixty three patients with AVF (66.3%) and 32 with AVG (33.7%) were included for the study.
Results: AVF group had more males (47.6%) compared to AVG group (37.5%) but the mean age in both the groups was almost similar with 57.1 and 57.2 years respectively. Primary survival was longer for AVF than AVG (34.1 vs 25.1 months; HR-3.85; 95% CI: 1.696-8.752; p=0.001). Thrombosis occurred more in AVG than AVF (59.4% vs 28.6%; p=0.007) and hence required more interventions (40.6% vs 12.7%; p=0.003). Interventions were more salvageable in AVG group compared to AVF (34.4% vs 11.1%; p=0.01). Infections were seen only in AVG (15.6% vs Nil; p=0.003). Total cumulative patency did not show significant difference between groups (38.5 months vs 33.3 months; HR-1.508; 95% CI 0.8-2.6; p=0.152). Mortality was high in patients with AVG compared to AVF (18.8% vs 4.8%; p=0.05).
Conclusion: Based on the study findings it can be stated that AVF has better primary access survival compared to AVG and graft requires more interventions which are more salvageable than fistula. Total cumulative patency between fistula and graft do not differ significantly.