A new contemporary comparative study will be presented during Friday’s Plenary Session 5 (8–9:30 a.m., West Building, Level 3, Skyline Ballroom) by author Theodore H. Yuo, MD, assistant professor at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, Pennsylvania. It will explore the creation of upper extremity arteriovenous (AV) access ipsilateral to central venous lesions, the options that are available in these cases, and how femoral AV grafts (fAVG) and the Hemodialysis Reliable Outflow (HeRO) device are both “valid” options for use in these cases, despite historically poorer outcomes.
Discussing their single-center, retrospective analysis of consecutive use of fAVG and HeRO, Yuo details that their evaluation concerned index AV accesses placed between 2014 and 2023. Cases were identified using the local Vascular Quality Initiative (VQI) database and supplemented by a review of surgeon case logs. Medical history, demographics and operative details were obtained utilizing a combination of VQI data and electronic medical records. Data were analyzed using standard statistical tests, Kaplan-Meier survival estimates, and multivariate Cox proportional hazards (PH) and logistic regressions.
To conduct the study, data for 99 patients were collected (57 HeRO, 42 fAVG), with a median follow-up of 464 days. Between the groups, there were no differences in female sex at birth and being non-White. Yuo et al found that the patients who received the HeRO were older, had higher body mass index (BMI), had fewer previous AV accesses, and were more likely to be diabetic. They also found that the ability to use the AV access for hemodialysis was similar in both groups, and mortality at 30 days occurred more frequently in the fAVG group. They stated that multivariate logistic regression also suggested that fAVG was associated with increased 30-day mortality.
When following up with the study participants one year after undergoing successful hemodialysis, primary, primary-assisted, and secondary patency rates were higher in the fAVG group. Multivariate PH analysis of the study results suggested that primary and primary assisted patency were similar in both groups, while fAVG was associated with improved secondary patency. Finally, the study also showed that graft removal due to infection occurred more frequently in the fAVG group.
The researchers concluded that, in this contemporary series comparing fAVG and HeRO, there were no differences in primary and primary-assisted patency. They did, however, find that there was improved secondary patency among the fAVG patients, as well as the fact that fAVG were associated with higher rates of perioperative mortality and graft infection.
Speaking to VS@VAM about the study, Yuo said: “The HeRO graft and femoral AVG are both reasonable options for ESKD [end-stage kidney disease] patients who are not candidates for standard upper extremity AV access.” He added, “This study evaluating our contemporary experience at UPMC reinforces their relative equivalence, though femoral AVG may have longer secondary patency. HeRO grafts enable extended use of the upper extremity, avoiding use of the lower extremity and the accompanying risks of that anatomic location.”
