Hybrid arteriovenous graft for hemodialysis vascular access in a multicenter registry.

Abstract

OBJECTIVE\nThe aim of our study was to identify patients characteristics that predicted a higher chance of arteriovenous graft patency in patients undergoing Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) implantation for hemodialysis access. The GHVG is a polytetrafluroethylene (PTFE) prosthesis with a nitinol-reinforced section (NRS) at the venous end.\n\n\nMETHODS\nAll consecutive patients undergoing GHVG implantation for hemodialysis access at 10 tertiary referral centers between December 2013 and January 2018 were included in the study and compared with a control group of patients undergoing standard PTFE graft implantation. Selection of patients for hybrid graft implantation was based on the impossibility of autogenous vascular access creation.\n\n\nRESULTS\nThere were 145 patients included in the GHVG group and 218 in the PTFE group. In the GHVG and the PTFE groups, the mean age was 67\xa0± 13\xa0years and 65\xa0± 13\xa0years, and male patients totaled 52% and 46%, respectively. The technical success was 99%. The mean duration of the intervention was 100\xa0minutes (median, 95\xa0minutes; interquartile range, 80-120\xa0minutes). The brachial-axillary configuration was used in the majority of cases (n\xa0= 78 [54%]). The 5-cm NRS length was prevalent (n\xa0= 108 [75%]). The median NRS oversize was 14% (interquartile range, 0%-21%). Mean follow-up was 13\xa0months (range, 0-55\xa0months). Seventy-one patients (49%) underwent at least one reintervention. Primary, assisted primary, and secondary patency estimates at 12\xa0months were 44%\xa0± 5%, 47%\xa0± 5%, and 65%\xa0± 4% for the GHVG group and 41%\xa0± 4%, 53%\xa0± 4%, and 75%\xa0± 3% for the control group, respectively (P\xa0= NS). One-year survival was 90%\xa0± 3%. On multivariable Cox regression analysis, hypotension (P\xa0< .001; hazard ratio [HR], 5.8; confidence interval [CI], 2.6-13) and diabetes (P\xa0= .024; HR, 1.9; CI, 1.1-3.2) were significant predictors of GHVG loss. A larger graft size was protective against GHVG loss (P\xa0= .042; HR, 0.73; CI, 0.54-0.99). The 10-cm-long graft showed a tendency toward improved patency but did not reach statistical significance (P\xa0= .074; HR, 0.48; CI, 0.21-1.07).\n\n\nCONCLUSIONS\nDiabetes and hypotension were predictors of loss of hybrid arteriovenous access. Smaller diameters of NRS were more prone to thrombosis, whereas the 10-cm length seemed to perform better than the 5-cm one.