Outcomes of upper arm axillary artery and brachial artery arteriovenous grafts.

BACKGROUND: We compared the outcomes of upper arm arteriovenous grafts (AVGs) in a large, prospectively collected data set to determine if there are clinically significant differences in axillary artery-based and brachial artery-based AVGs. METHODS: Patients who received upper arm AVGs within the Society of Vascular Surgery Vascular Quality Initiative (VQI) dataset were identified. The primary outcome measures were primary and secondary patency loss at 12-month follow-up. Other outcomes included were wound infection, steal syndrome, and arm swelling at 6-month follow-up. The log-rank test was used to evaluate patency loss using Kaplan-Meier analysis, and Cox proportional hazards models were used to examine adjusted association between inflow artery (brachial artery vs axillary artery) and outcomes, adjusting for configuration (straight vs looped). RESULTS: Among 3637 upper extremity AVGs in the VQI (2010-2017), there were 510 upper arm brachial artery AVGs and 394 upper arm axillary artery AVGs. Patients with axillary artery AVGs were more likely to be female (72% vs 56%, p < 0.001) and underwent general anesthesia (61% vs 57%, p < 0.05). In univariable analysis, the 12-month primary patency (54% vs 63%, p = 0.03) and secondary patency (81% vs 89%, p = 0.007) were lower for axillary artery AVGs than upper arm brachial artery AVGs. In multivariable analysis, although wound infection and arm swelling were similar at 6-month follow up, axillary artery AVGs were more likely to have steal syndrome (adjusted Hazard Ratio (aHR) = 2.6, 95% Confidence Interval (CI) 1.2,5.6, p = 0.017). In addition, axillary artery AVGs were associated with higher rates of 12-month primary patency loss (aHR = 1.6, 95% CI 1.2-2.2, p = 0.002) and 12-month secondary patency loss (aHR = 2.0, 95% CI 1.3-3.3, p = 0.005). CONCLUSIONS: From this observational study analyzing the outcomes of upper extremity hemodialysis access, axillary artery AVGs were associated with significantly lower patency rates and higher risk of steal syndrome than brachial artery AVGs.

Upper Arm Arteriovenous Grafts are Superior over Forearm Arteriovenous Grafts in Upper Extremity Dialysis Access.

BACKGROUND: In this study, we compared the outcomes of forearm arteriovenous grafts (AVGs) and upper arm AVGs in a large, prospectively collected data set, which represents real-world experience with upper extremity prosthetic dialysis access, to determine if there are clinically significant differences in the upper arm and forearm positions. METHODS: We identified 2,063 patients who received upper extremity AVGs within the Vascular Quality Initiative data set (2010-2018). Axillary to axillary upper arm AVGs were excluded (n = 394) from the analysis. The main outcome measures were primary and secondary patency rates at 12 months. Other outcomes were 6-month wound infection, steal syndrome, and arm swelling. The log-rank test was used to evaluate patency loss using a Kaplan-Meier analysis. Cox proportional hazards models were used to examine adjusted association between locations (forearm and upper arm) and outcomes. RESULTS: There were 1,160 forearm AVGs and 509 upper arm brachial artery AVGs in the study cohort. Patients with forearm AVGs were more likely to have a body mass index > 30 (45% vs. 38%, P = 0.013), no history of previous access (73% vs. 63%, P < 0.001), and underwent local-regional anesthesia (56% vs. 43%, P < 0.001). The 12-month primary patency (51.5% vs. 62.9%, P < 0.001) and secondary patency (76.4% vs. 89.1%, P < 0.001) were significantly lower for forearm AVGs. Wound infection, steal syndrome, and arm swelling were similar between forearm AVGs and upper arm AVGs at the 6-month follow-up. In multivariable analysis, the primary patency loss (adjusted hazard ratio (aHR) 1.66, 95% confidence interval (CI) 1.33-2.01, P < 0.001) and 12-month secondary patency loss (aHR 2.71, 95% CI 1.84-3.98, P < 0.001) were significantly higher for forearm AVGs at 12 months. CONCLUSIONS: From this observational study of the Vascular Quality Initiative data set, the primary and secondary patency rates were superior for upper arm brachial artery AVGs compared with forearm AVGs.