Universität zu Köln

Shahverdyan, Robert ORCID: 0000-0002-8352-0954, Beathard, Gerald, Mushtaq, Nasir ORCID: 0000-0002-2686-7601, Litchfield, Terry F., Vartanian, Shant, Konner, Klaus and Jennings, William C. (2021). Comparison of Ellipsys Percutaneous and Proximal Forearm Gracz-Type Surgical Arteriovenous Fistulas. Am. J. Kidney Dis., 78 (4). S. 520 - 531. PHILADELPHIA: W B SAUNDERS CO-ELSEVIER INC. ISSN 1523-6838

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Abstract

Rationale & Objective: Percutaneous arteriovenous fistulas (AVF) are created by establishing a proximal forearm anastomosis and offer a safe and reliable vascular access. This study compares the Ellipsys percutaneous AVF with a proximal forearm Gracz-type surgical AVF, chosen for comparison as it is constructed at the same anatomical site. Study Design: Retrospective study of prospectively collected clinical data. Setting & Participants: All vascular access procedures conducted during a 34-month period were reviewed. The study groups comprised 89 percutaneous AVFs and 69 surgical AVFs. Exposure: Percutaneous or surgical AVF placement. Outcome: AVF patency, function, and complications. Analytical Approach: Patency rates for each AVF group were evaluated by competing risk survival analysis using a cumulative incidence function. Association of primary, primary assisted, and secondary patency with the AVF groups was examined by Cox proportional hazard models. Results: Technical success was 100% for both groups. Average procedure times were 14 minutes for percutaneous AVFs and 74 minutes for surgical AVFs (P < 0.001). Proximal radial artery (PRA) was used in all percutaneous AVF cases. Inflow for surgical AVFs included radial (30%), ulnar (12%), and brachial (58%) arteries. Outflow veins for both groups were the cephalic and/or basilic veins. Access flow volumes, times to maturation, and overall numbers of interventions per patient-year were not significantly different. Cumulative incidence of primary patency failure at 12 months was lower for surgical AVF (47% vs 64%, P = 0.1), but secondary patency failure was not different between groups (20% vs 12%, P = 0.3). PRA surgical AVFs had similar primary patency (65% vs 64%, P = 0.8) but higher secondary patency failure rates than percutaneous AVFs at 12 months (34% vs 12%, P = 0.04). Limitations: Retrospective study with a relatively short follow-up period, and not all patients required hemodialysis at the end of study. Conclusions: Both percutaneous and surgical AVFs demonstrated high rates of technical success and secondary patency. Percutaneous AVFs required shorter procedure times. The rate of intervention was similar. When a distal radial artery AVF is not feasible, percutaneous AVF might offer an appropriate procedure for creating a safe and functional access, maintaining further proximal forearm surgical AVF creation options.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Shahverdyan, Robert UNSPECIFIED orcid.org/0000-0002-8352-0954 UNSPECIFIED Beathard, Gerald UNSPECIFIED UNSPECIFIED UNSPECIFIED Mushtaq, Nasir UNSPECIFIED orcid.org/0000-0002-2686-7601 UNSPECIFIED Litchfield, Terry F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vartanian, Shant UNSPECIFIED UNSPECIFIED UNSPECIFIED Konner, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Jennings, William C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-596277
DOI:	10.1053/j.ajkd.2021.01.011
Journal or Publication Title:	Am. J. Kidney Dis.
Volume:	78
Number:	4
Page Range:	S. 520 - 531
Date:	2021
Publisher:	W B SAUNDERS CO-ELSEVIER INC
Place of Publication:	PHILADELPHIA
ISSN:	1523-6838
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MIDDLE-ARM FISTULA; VASCULAR ACCESS; HEMODIALYSIS-PATIENTS; CREATION; MAINTENANCE; GUIDELINES; OUTCOMES; FAILURE Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59627