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Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula
Author(s) -
Ramani Karthik,
Kallam Ajay,
Zibari Gazi,
Caldito Gloria,
Ram Sunanda J.,
Abreo Kenneth D.,
Sequeira Adrian
Publication year - 2012
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12004
Subject(s) - medicine , fistula , hemodialysis access , surgery , hemodialysis , thrombosis , dysfunctional family , vein , retrospective cohort study , arteriovenous fistula , survival rate , vascular access , clinical psychology
Nonmaturing or dysfunctional hemodialysis fistulas are often repaired with interposition grafts placed either within the fistula (fistula‐to‐fistula configuration), or connected to another vein (fistula‐to‐vein configuration). The goal of this study was to compare the survival and usefulness of the composite accesses thus created, which we call “graftulas,” with upperarm grafts. This was a retrospective study wherein we determined the survival and thrombosis rates of graftulas ( n = 24) and upper arm grafts ( n = 31) placed 1/1/07 through 12/31/09 and followed through 11/30/10. Graftulas resembled grafts as most (96%) were successfully cannulated in 65 ± 43 days. Survival of graftulas was also similar to grafts (58%, 47%, and 32% vs. 56%, 47%, and 39% at 1, 2, and 3 years respectively, p = 0.60). However, graftulas had a lower thrombosis rate than grafts (0.5 vs. 1.2 per patient year, p = 0.04), and in the fistula‐to‐fistula configuration, a 2‐year thrombosis‐free survival of 78%. Total survival of the access site (fistula + graftula) was 92%, 73%, and 42% at 1, 3, and 5 years, respectively. Graftulas possess certain beneficial properties of fistulas and grafts that allows for continued use of the original access site.