Arteriovenous grafts are associated with earlier catheter removal and fewer catheter days in the United States Renal Data System population
| Autor: | Theodore H. Yuo, Steven A. Leers, Michel S. Makaroun, Rabih A. Chaer, Larry Fish, Ellen D. Dillavou, Andrew E. Leake, Timothy Wu |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Catheterization Central Venous Time Factors Databases Factual medicine.medical_treatment Population Blood Vessel Prosthesis Implantation Arteriovenous Shunt Surgical Catheters Indwelling Renal Dialysis Risk Factors medicine Odds Ratio Central Venous Catheters Humans education Dialysis Device Removal Vascular Patency Aged Retrospective Studies Thrombectomy education.field_of_study business.industry Graft Occlusion Vascular Thrombosis Dialysis catheter Odds ratio Vascular surgery United States Surgery Catheter Logistic Models Treatment Outcome Multivariate Analysis Current Procedural Terminology Female Hemodialysis Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of vascular surgery. 62(1) |
| ISSN: | 1097-6809 |
| Popis: | Arteriovenous fistulas (AVFs) are associated with improved long-term outcomes but longer maturation times and higher primary failure rates compared with arteriovenous grafts (AVGs). The Fistula First Breakthrough Initiative has recently emphasized tunneled dialysis catheter (TDC) avoidance. We sought to characterize the relationship of AVFs and AVGs to the use of TDCs as well as secondary procedures.Using the United States Renal Data System (USRDS) database, we identified incident hemodialysis (HD) patients in 2005 that started HD with a TDC and survived at least 1 year. We then monitored them through 2008. Access creation, TDC removal, TDC placement, and secondary procedures were identified by Current Procedural Terminology codes (American Medical Association, Chicago, Ill). Multivariate logistic regression was used to identify risk factors for the primary end points.In 2005, HD was initiated in 56,495 patients, 74% with a TDC. Of these, 6286 had an access procedure ≤3 months and 1 year of follow-up (AVF, 4634; AVG, 1652). Mean age was 67.7 years (AVF, 67.3; AVG, 68.7 years; P.001), 53.3% were men (AVF, 58.1%; AVG, 40.5%; P.001), and 33.8% were obese (AVF, 33.6%; AVG, 34.4%; P = not significant). AVG placement was associated with a higher TDC removal at 1 (7.9% vs 3.1%; P.001), 3 (47.8% vs 17.8%; P.001), and 6 (60.6% vs 47.2%; P.001) months. There was no difference at 9 months (AVG, 64.9% vs AVF, 62.3%; P = .06). The median time to TDC removal was lower in the AVG group (70 days vs 155 days; P.001). Multivariable model found AVFs were associated with decreased odds of TDC removal at 3 (odds ratio, 0.22; P.001) and 6 months (odds ratio, 0.54; P.001). AVGs required more secondary procedures than AVFs at all time points up to 1 year and specifically had increased thrombectomy procedures (39.8% vs 11.5%; P.001).In patients starting dialysis with a TDC, AVGs are associated with increased TDC removal and fewer catheter days compared with AVFs at up to 6 months. However, AVGs require more secondary procedures at all time points up to 1 year. |
| Databáze: | OpenAIRE |
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