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Comparison of standard forearm prosthetic loop grafts to composite semiloop forearm grafts (“semi‐grafts”) in hemodialysis patients: A prospective study
Author(s) -
Georgiadis George S.,
Antoniou George A.,
Kantartzi Konstantia,
Georgakarakos Efstratios I.,
Argyriou Christos,
Passadakis Ploumis,
Lazarides Miltos K.
Publication year - 2017
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12482
Subject(s) - medicine , cephalic vein , surgery , hemodialysis , forearm , brachial artery , vein , stenosis , hemodialysis access , cardiology , vascular access , blood pressure
To prospectively assess the performance of composite semiloop antebrachial grafts (“semi‐grafts,” SGs) in hemodialysis patients. Methods: Eighty‐five patients who received 67 loop antebrachial grafts (LG‐group) and 25 antebrachial semigrafts (SG‐group) were enrolled. SGs were defined as those originating from the brachial artery and anastomosed with the proximal mature mid‐antebrachial cephalic vein. Cephalic vein length should be at least 10 cm in length and of ≥5 mm in diameter for inclusion in the SG‐group. LG‐group included all possible outflow vein options of minimum diameter 3 mm. Kaplan‐Meier statistics was used for comparison of groups. Findings: Main indication for a SG was a failing radiocephalic fistula with extensive distal cephalic vein stenosis not amenable to correction or failed after endovascular repair or requiring long interposition grafting. The mean follow‐up period was 20.16 ± 22.6 and 29.6 ± 36.7 months for the LG‐ and SG‐group, respectively (P = 0.14). Forty‐two patients died during the follow‐up. Primary patency (up to first intervention or failure) at 6 and 12 months for LG‐ vs. SG‐group was 93.9% vs. 83.7% and 47% vs. 55.8% (P = 0.08). Secondary patency (up to abandonment) was 58.2% vs. 61.1% and 36% vs. 45.8% at 12 and 24 months (P = 0.18). Mortality at 48 months was 22.4% (LG‐group) and 24% (SG‐group) (P = 0.9). Discussion: There was a trend toward better primary and secondary patency rates for the SGs especially in the long‐term. This is a valuable option in selected patients that access surgeons and nephrologists should be aware of.