Comparison of outcomes of arteriovenous grafts and fistulas at a single Veterans' Affairs medical center

Abstract 

Background

Before 2003, almost all dialysis access procedures performed at the G.V. Montgomery Veterans' Affairs Medical Center were arteriovenous grafts. In mid-2003, it was decided to place fistulas in most patients. This study compared the patency rates and frequency of interventions to maintain function between the 2 procedures.

Methods

Patency rates for 64 grafts and 50 fistulas were computed using Kaplan-Meier life-tables and compared using the Cox-Mantel log- rank test. The frequency of interventions to maintain function was compared using a Poisson model.

Results

Primary patency of grafts at 1 and 2 years was 39% and 26%, and that of fistulas was 44% and 37%. Secondary patency of grafts at 1 and 2 years was 71% and 63%, and that of fistulas was 75% and 72%. Neither difference reached significance. The difference in interventions also was insignificant.

Conclusions

Switching from grafts to fistulas did not significantly improve the patency and frequency of interventions.

Keywords: Hemodialysis access, Arteriovenous grafts, Arteriovenous fistulas