The influence of graft diameter on the patency rates of axillaryaxillary arteriovenous grafts in hemodialysis patients

Abstract

Introduction : End-stage renal disease (ESRD) arises from several heterogeneous disease pathways that permanent alter renal function and structure over months or years. Hemodialysis (HD) is a lifeline treatment for cases with ESRD. A ratio of HD cases exhaust all methods for permanent vascular access (fistula or graft) in both upper limbs. Aim: The current study aims to compare 8 and 6 mm extended polytetrafluoroethylene (PTFE) grafts according to the primary patency in cases undergoing axi-ax arteriovenous grafts. Patients and methods: This retrospective, prospective case–control cohort study included all patients with ESRD referred to the Vascular Outpatient Clinic, Mansoura University hospitals, seeking for creation of HD access and decided for arteriovenous synthetic graft due to the lack of suitable autogenous veins in the arms patient were classified into two groups, in the first group (A) an 8 mm PTFE graft (26 patients) in the second group (B) a 6 mm PTFE graft, grafts (21 patients) were placed on the chest wall anastomosed between first part axillary artery and axillary vein. Results : This study was conducted on 47 patients, a 6 mm graft was used on 21 patients and an 8 mm graft on 26 patients. There was a statistically significant difference between the graft 6 mm group and the graft 8 mm group regarding preoperative axillary artery diameter and preoperative vein diameter ( P < 0.001 and 0.001, respectively) and significant difference between graft 6 mm group and graft 8 mm group regarding complications (thrombosis) ( P = 0.033). And nonsignificant regarding infection ( P = 1.0). Conclusion : The current study revealed that without considering certain changes in 6 and 8 mm grafts, primary patency can be improved by placing 8 mm grafts while respecting the axillary artery and vein diameters.