Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas

Hung Michael Choi, Brajesh K. Lal, Joaquim J. Cerveira, Frank T. Padberg, Michael Silva, Robert W. Hobson, Peter J. Pappas, David P. Franklin, David Fox, Linda Harris, Enrico Ascher, Matthew J. Dougherty

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives: Preoperative duplex scanning of arm and forearm veins has increased the creation of autogenous arteriovenous (AV) fistulas. However, the cumulative functional patency and durability of transposed AV fistulas (TAVF) compared with nontransposed AV fistulas (AVF) and prosthetic bridging grafts (AVG) remains ill-defined. Methods: From January 1998 to December 2002, 245 dialysis access procedures were performed at University Hospital and the Veteran Affairs Medical Center in New Jersey. Follow-up data were available for 125 procedures (TAVF, n = 42; AVF, n = 30; AVG, n = 53) performed in 97 patients. All access procedures were planned on the basis of preoperative duplex scans of arm and forearm veins. Functional patency was defined as ability to cannulate and hemodialyze patients successfully. Primary and secondary cumulative functional patency of TAVFs, AVFs, and AVGs was determined with life table analysis, and differences were analyzed with the log-rank test. Differences in revision rates, including thrombolysis, thrombectomies, and operative revisions, were determined with the Fisher exact t test. Results: Mean follow-up was 18 months (range, 4-24 months). For TAVFs, AVFs, and AVGs, primary functional patency rate at 1 year was 76.2%, 53.3%, and 47.2%, respectively, and at 2 years was 67.7%, 34.4%, and 25.5%, respectively. Similarly, secondary functional patency rate at 1 year was 83.2%, 66.7%, and 58.5%, respectively, and at 2 years was 74.6%, 56.2%, and 40.2%, respectively. Primary and secondary functional patency rates for TAVFs were superior to those for AVGs at 1 and 2 years (P < .001). AVFs had superior secondary functional patency rate at 2 years, compared with AVGs (P < .05), and TAVFs had superior primary and secondary patency rates at 2 years, compared with AVFs (P < .05). AVGs required significantly more revisions than did TAVFs (28.5% vs 54.7%; P < .001) or AVFs (36.7% vs 54.7%; P < .05). Conclusions: Preoperative duplex scanning of upper arm and forearm veins facilitated successful creation of all types of autogenous fistulas at our institution. TAVF cumulative functional patency rates were superior compared with AVGs and AVFs. Furthermore, TAVFs and AVFs were more durable and required fewer revisions than did AVGs. When preoperative duplex criteria indicate that TAVFs can be performed, they should be the initial access of choice, because of their superior long-term patency and durability.

Original languageEnglish (US)
Pages (from-to)1206-1212
Number of pages7
JournalJournal of Vascular Surgery
Volume38
Issue number6
DOIs
StatePublished - Dec 2003
Externally publishedYes

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Arteriovenous Fistula
Fistula
Forearm
Veins
Arm
Thrombectomy
Life Tables
Veterans
Dialysis
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Choi, H. M., Lal, B. K., Cerveira, J. J., Padberg, F. T., Silva, M., Hobson, R. W., ... Dougherty, M. J. (2003). Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas. Journal of Vascular Surgery, 38(6), 1206-1212. https://doi.org/10.1016/j.jvs.2003.08.020

Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas. / Choi, Hung Michael; Lal, Brajesh K.; Cerveira, Joaquim J.; Padberg, Frank T.; Silva, Michael; Hobson, Robert W.; Pappas, Peter J.; Franklin, David P.; Fox, David; Harris, Linda; Ascher, Enrico; Dougherty, Matthew J.

In: Journal of Vascular Surgery, Vol. 38, No. 6, 12.2003, p. 1206-1212.

Research output: Contribution to journalArticle

Choi, HM, Lal, BK, Cerveira, JJ, Padberg, FT, Silva, M, Hobson, RW, Pappas, PJ, Franklin, DP, Fox, D, Harris, L, Ascher, E & Dougherty, MJ 2003, 'Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas', Journal of Vascular Surgery, vol. 38, no. 6, pp. 1206-1212. https://doi.org/10.1016/j.jvs.2003.08.020
Choi, Hung Michael ; Lal, Brajesh K. ; Cerveira, Joaquim J. ; Padberg, Frank T. ; Silva, Michael ; Hobson, Robert W. ; Pappas, Peter J. ; Franklin, David P. ; Fox, David ; Harris, Linda ; Ascher, Enrico ; Dougherty, Matthew J. / Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas. In: Journal of Vascular Surgery. 2003 ; Vol. 38, No. 6. pp. 1206-1212.
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title = "Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas",
abstract = "Objectives: Preoperative duplex scanning of arm and forearm veins has increased the creation of autogenous arteriovenous (AV) fistulas. However, the cumulative functional patency and durability of transposed AV fistulas (TAVF) compared with nontransposed AV fistulas (AVF) and prosthetic bridging grafts (AVG) remains ill-defined. Methods: From January 1998 to December 2002, 245 dialysis access procedures were performed at University Hospital and the Veteran Affairs Medical Center in New Jersey. Follow-up data were available for 125 procedures (TAVF, n = 42; AVF, n = 30; AVG, n = 53) performed in 97 patients. All access procedures were planned on the basis of preoperative duplex scans of arm and forearm veins. Functional patency was defined as ability to cannulate and hemodialyze patients successfully. Primary and secondary cumulative functional patency of TAVFs, AVFs, and AVGs was determined with life table analysis, and differences were analyzed with the log-rank test. Differences in revision rates, including thrombolysis, thrombectomies, and operative revisions, were determined with the Fisher exact t test. Results: Mean follow-up was 18 months (range, 4-24 months). For TAVFs, AVFs, and AVGs, primary functional patency rate at 1 year was 76.2{\%}, 53.3{\%}, and 47.2{\%}, respectively, and at 2 years was 67.7{\%}, 34.4{\%}, and 25.5{\%}, respectively. Similarly, secondary functional patency rate at 1 year was 83.2{\%}, 66.7{\%}, and 58.5{\%}, respectively, and at 2 years was 74.6{\%}, 56.2{\%}, and 40.2{\%}, respectively. Primary and secondary functional patency rates for TAVFs were superior to those for AVGs at 1 and 2 years (P < .001). AVFs had superior secondary functional patency rate at 2 years, compared with AVGs (P < .05), and TAVFs had superior primary and secondary patency rates at 2 years, compared with AVFs (P < .05). AVGs required significantly more revisions than did TAVFs (28.5{\%} vs 54.7{\%}; P < .001) or AVFs (36.7{\%} vs 54.7{\%}; P < .05). Conclusions: Preoperative duplex scanning of upper arm and forearm veins facilitated successful creation of all types of autogenous fistulas at our institution. TAVF cumulative functional patency rates were superior compared with AVGs and AVFs. Furthermore, TAVFs and AVFs were more durable and required fewer revisions than did AVGs. When preoperative duplex criteria indicate that TAVFs can be performed, they should be the initial access of choice, because of their superior long-term patency and durability.",
author = "Choi, {Hung Michael} and Lal, {Brajesh K.} and Cerveira, {Joaquim J.} and Padberg, {Frank T.} and Michael Silva and Hobson, {Robert W.} and Pappas, {Peter J.} and Franklin, {David P.} and David Fox and Linda Harris and Enrico Ascher and Dougherty, {Matthew J.}",
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T1 - Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas

AU - Choi, Hung Michael

AU - Lal, Brajesh K.

AU - Cerveira, Joaquim J.

AU - Padberg, Frank T.

AU - Silva, Michael

AU - Hobson, Robert W.

AU - Pappas, Peter J.

AU - Franklin, David P.

AU - Fox, David

AU - Harris, Linda

AU - Ascher, Enrico

AU - Dougherty, Matthew J.

PY - 2003/12

Y1 - 2003/12

N2 - Objectives: Preoperative duplex scanning of arm and forearm veins has increased the creation of autogenous arteriovenous (AV) fistulas. However, the cumulative functional patency and durability of transposed AV fistulas (TAVF) compared with nontransposed AV fistulas (AVF) and prosthetic bridging grafts (AVG) remains ill-defined. Methods: From January 1998 to December 2002, 245 dialysis access procedures were performed at University Hospital and the Veteran Affairs Medical Center in New Jersey. Follow-up data were available for 125 procedures (TAVF, n = 42; AVF, n = 30; AVG, n = 53) performed in 97 patients. All access procedures were planned on the basis of preoperative duplex scans of arm and forearm veins. Functional patency was defined as ability to cannulate and hemodialyze patients successfully. Primary and secondary cumulative functional patency of TAVFs, AVFs, and AVGs was determined with life table analysis, and differences were analyzed with the log-rank test. Differences in revision rates, including thrombolysis, thrombectomies, and operative revisions, were determined with the Fisher exact t test. Results: Mean follow-up was 18 months (range, 4-24 months). For TAVFs, AVFs, and AVGs, primary functional patency rate at 1 year was 76.2%, 53.3%, and 47.2%, respectively, and at 2 years was 67.7%, 34.4%, and 25.5%, respectively. Similarly, secondary functional patency rate at 1 year was 83.2%, 66.7%, and 58.5%, respectively, and at 2 years was 74.6%, 56.2%, and 40.2%, respectively. Primary and secondary functional patency rates for TAVFs were superior to those for AVGs at 1 and 2 years (P < .001). AVFs had superior secondary functional patency rate at 2 years, compared with AVGs (P < .05), and TAVFs had superior primary and secondary patency rates at 2 years, compared with AVFs (P < .05). AVGs required significantly more revisions than did TAVFs (28.5% vs 54.7%; P < .001) or AVFs (36.7% vs 54.7%; P < .05). Conclusions: Preoperative duplex scanning of upper arm and forearm veins facilitated successful creation of all types of autogenous fistulas at our institution. TAVF cumulative functional patency rates were superior compared with AVGs and AVFs. Furthermore, TAVFs and AVFs were more durable and required fewer revisions than did AVGs. When preoperative duplex criteria indicate that TAVFs can be performed, they should be the initial access of choice, because of their superior long-term patency and durability.

AB - Objectives: Preoperative duplex scanning of arm and forearm veins has increased the creation of autogenous arteriovenous (AV) fistulas. However, the cumulative functional patency and durability of transposed AV fistulas (TAVF) compared with nontransposed AV fistulas (AVF) and prosthetic bridging grafts (AVG) remains ill-defined. Methods: From January 1998 to December 2002, 245 dialysis access procedures were performed at University Hospital and the Veteran Affairs Medical Center in New Jersey. Follow-up data were available for 125 procedures (TAVF, n = 42; AVF, n = 30; AVG, n = 53) performed in 97 patients. All access procedures were planned on the basis of preoperative duplex scans of arm and forearm veins. Functional patency was defined as ability to cannulate and hemodialyze patients successfully. Primary and secondary cumulative functional patency of TAVFs, AVFs, and AVGs was determined with life table analysis, and differences were analyzed with the log-rank test. Differences in revision rates, including thrombolysis, thrombectomies, and operative revisions, were determined with the Fisher exact t test. Results: Mean follow-up was 18 months (range, 4-24 months). For TAVFs, AVFs, and AVGs, primary functional patency rate at 1 year was 76.2%, 53.3%, and 47.2%, respectively, and at 2 years was 67.7%, 34.4%, and 25.5%, respectively. Similarly, secondary functional patency rate at 1 year was 83.2%, 66.7%, and 58.5%, respectively, and at 2 years was 74.6%, 56.2%, and 40.2%, respectively. Primary and secondary functional patency rates for TAVFs were superior to those for AVGs at 1 and 2 years (P < .001). AVFs had superior secondary functional patency rate at 2 years, compared with AVGs (P < .05), and TAVFs had superior primary and secondary patency rates at 2 years, compared with AVFs (P < .05). AVGs required significantly more revisions than did TAVFs (28.5% vs 54.7%; P < .001) or AVFs (36.7% vs 54.7%; P < .05). Conclusions: Preoperative duplex scanning of upper arm and forearm veins facilitated successful creation of all types of autogenous fistulas at our institution. TAVF cumulative functional patency rates were superior compared with AVGs and AVFs. Furthermore, TAVFs and AVFs were more durable and required fewer revisions than did AVGs. When preoperative duplex criteria indicate that TAVFs can be performed, they should be the initial access of choice, because of their superior long-term patency and durability.

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