VESS18. Arteriovenous Graft (AVG) Is Associated with Increased Secondary Procedures but Lower Catheter Use than Arteriovenous Fistula (AVF)
2:00 p.m.
Andrew E. Leake, Theodore H. Yuo, Timothy Wu, Larry Fish, Ellen D. Dillavou, Rabih A. Chaer, Steven A. Leers, Michel S. Makaroun.
University of Pittsburgh Medical Center, Pittsburgh, Pa.
OBJECTIVES: AVF is associated with improved long-term outcomes but longer maturation periods than AVG. The Fistula First Breakthrough Initiative has recently emphasized TDC avoidance. We sought to characterize the relationship of AVF and AVG to the utilization of TDCs as well as secondary procedures, defined as surgical revision, fistulogram and thrombectomy. METHODS: Using the US Renal Data System (USRDS) database, we identified incident HD patients in 2005 who started HD with a TDC and survived at least one year. Access creation, TDC placement and secondary procedures were identified by CPT codes. Multivariate logistic regression was used to identify risk factors for TDC placement or secondary procedures. RESULTS: 56,839 patients started HD in 2005, 73% with a TDC. Of those patients, 6,286 had an access procedure within 3 months and had at least one year of follow-up available (AVF 4,634; AVG 1,652). Mean age was 67.7 years (AVF 67.4, AVG 68.7; P<.001), 53.3% were male (AVF 57.9%, AVG 40.5%; P<.001), and 33.9% were obese (AVF 33.6%, AVG 34.6%; P=NS). Multivariate logistic regression demonstrates that AVG is associated with more secondary procedures (OR 1.403, P<.001) but significantly lower TDC use (OR 0.845, P=.006). Lower BMI, white race, older age, and male gender also protect against TDC placement (Table). Lower BMI, male gender, white race and younger age are protective against secondary procedures. CONCLUSIONS: In patients starting dialysis with TDC, AVG is associated with increased secondary procedures but lower TDC placement at one year. AUTHOR DISCLOSURES: R.A. Chaer: Nothing to disclose; E.D. Dillavou: Nothing to disclose; L. Fish: Nothing to disclose; A.E. Leake: Nothing to disclose; S.A. Leers: Nothing to disclose; M.S. Makaroun: Nothing to disclose; T. Wu: Nothing to disclose; T.H. Yuo: Nothing to disclose. One-Year Predictors of TDC Placement and Secondary Procedures Predictor
TDC Placement
Secondary Procedures
AV Graft
0.845 (.006)
1.403 (<.001)
Age (per decade)
0.949 (.020)
1.057 (.014)
White Race
0.864 (.012)
0.731 (<.001)
Male Gender
0.0831 (.001)
0.945 (.298)
BMI (per 5 units)
1.046 (.015)
1.06 (.002)
Odds Ratio (P-value)
Vascular Annual Meeting 2014 • June 5 – 7, 2014 • Boston, Massachusetts
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