Evaluation and comparison of patency rate and complications of synthetic arteriovenous grafts in the groin and upper extremities among hemodialysis patients

Abstract

Background: Arteriovenous (AV) grafts are frequently used for hemodialysis when an AV fistula is not feasible. Recent improvements in prosthetic materials have led to comparable performance of upper and lower extremity grafts. We aimed to evaluate the patency
rate (the time from initial placement to failure or intervention) and complications of groin versus upper extremity AV grafts.

Materials and Methods: In this cross?sectional study, conducted from October 2018 to October 2020 at a tertiary referral center, patients with either a lower extremity (groin) or upper extremity AV graft were included and followed for at least 2 years. Graft adequacy was defined as the ability to deliver a blood flow ?350 mL/min with two?needle annulation in ?5 dialysis sessions in 1 month. Outcomes included infection, ischemia, neuropathy, and thrombosis. Statistical tests (Chi?square for categorical variables and t?test for continuous variables) were used, with P < 0.05 considered statistically significant.

Results: Among 213 hemodialysis patients (mean age: 54.4 ± 17.4 years, 68.5% of males), 183 had upper extremity AV grafts and 30 had groin AV grafts. No significant
differences were observed between the two groups for patency duration (P = 0.088) or rates of infection, ischemia, neuropathy, thrombosis, and graft adequacy (all P > 0.05).

Conclusion: In this cohort, groin AV grafts had similar patency and complication profiles compared to those in the upper extremities. Groin placement can be a viable alternative when upper extremity access is not suitable. Further studies using standardized graft materials and longer follow?up intervals are recommended.