CVC impact on arteriovenous graft outcomes
Abstract:
Objective: Central venous stenosis is a common problem that diminishes vascular access lifespan. Current national guidelines recommend that central catheters and arteriovenous grafts (AVG) be placed contralateral to an existing hemodialysis access. We set forth to delineate any clinically significant outcomes based on laterality in patients undergoing AVG placement with an existing central catheter for dialysis treatments.
Methods: Using a Veterans Administration Hospital dialysis access database over a four-year period (May 2014 to April 2018), we identified all patients who underwent AVG placement in an upper extremity with an existing ipsilateral (Ispi-CL-) or contralateral (Contra-CL) central line for hemodialysis. Arteriovenous graft outcomes examined included successful cannulation, functional patency, thrombosis events, and endovascular interventions per access site. Clinical records were also examined for location of AVG, AVF or AVG precursors, prior central line placement, peripherally inserted central catheter (PICC), and cardiac venous access. All outcomes were followed until July 2021. Student’s t-test, Fisher’s Exact test, and multivariable analysis were utilized.
Results: A total of 71 AVGs. 55 (77%) were placed contralateral to existing central venous catheters and 16 (23%) were placed on the ipsilateral side. Baseline characteristics between the two groups were not found to be significantly different. This included history of hypertension, smoking history, prior AV access, BMI, race, glucose, creatinine, BUN, hemoglobin, MCV, platelet count, antiplatelet agent, anticoagulation. 100% (n=16) of patients in the Ipsi-CL group had previous central venous access compared to 49.1% (n=27) in Contra-CL (p=<0.001). The mean functional patency for AVG with Contra-CL was 724.78 ± 593.98 days compared to AVGs with Ipsi-CL with mean days of 350.94 ± 431.23 days (p=0.001). History of previous central venous catheterization and graft on ipsilateral side of a catheter at time of surgery was associated with decreased functional duration of graft (odds ratio, 0.25; p=0.03).
Conclusions: Within this cohort of patients that underwent AVG, we noted a statistically significant decrease in the duration of functional patency of grafts with ipsilateral to central venous catheters. We did not find a difference in cannulation rates, thrombosis events or overall endovascular interventions. Ipsilateral central access appears to be associated with decreased functional patency of AVGs. These findings highlight a discrepancy that is potentially clinically relevant and further studies are warranted.
Reference:
Otoya D, Simmonds A, Lavingia K, Amendola MF. Central Line Access for Hemodialysis Adversely Affects Ipsilateral Arteriovenous Graft Outcomes. Ann Vasc Surg. 2022 May 13:S0890-5096(22)00229-1. doi: 10.1016/j.avsg.2022.04.043. Epub ahead of print. PMID: 35577272.