Arteriovenous grafts have higher secondary patency in the short term compared with autologous fistulae Matthew T. Allemang, M.D. a , Brian Schmotzer, M.S. b , Virginia L. Wong, M.D. a , Ryan O. Lakin, M.D. a , Kenneth J. Woodside, M.D. c , James A. Schulak, M.D. c , John Wang, M.D. a , Vikram S. Kashyap, M.D. a, * a Division of Vascular Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; b Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, USA; and c Division of Transplant Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA KEYWORDS: Dialysis access; Prosthetic graft; PTFE; Patency Abstract BACKGROUND: To estimate patency of arteriovenous fistulas (AVFs) and grafts (AVGs) for dialysis access. METHODS: Records of all adult patients who had a dialysis access placed from January 2008 to June 2011 were retrospectively reviewed. RESULTS: A total of 494 patients with 655 accesses (390 AVFs, 265 AVGs) were examined. We found that AVG fared worse in assisted primary patency. But AVG had superior secondary patency up to 1.2 years (hazard ratio [HR] .6, confidence interval [CI]: [.4 to .8]) and was no different than AVF after 1.2 years. (HR 1.6, CI: [.9 to 3.1]). On univariate analysis, dialysis catheters negatively impacted assisted primary patency (HR 1.4, CI: [1.09 to 1.77]). CONCLUSIONS: AVG can be maintained with higher rates of secondary patency in the short term and are no different in the long term. This result suggests that in patients with limited life expectancy an AVG may be an effective alternative to an AVF to reduce both catheter time and associated complications. Ó 2014 Elsevier Inc. All rights reserved. In the 2012 United States Renal Data System Annual Data Report, end-stage renal disease (ESRD) patients between the ages of 65 and 74 had a mortality rate of 42% at 2 years. This rate was even higher for patients 75 years or older (58%). The number of older patients initiating dialysis is continuing to increase. 1,2 The current guidelines emphasize placement of autologous arteriove- nous fistula (AVF) instead of arteriovenous graft (AVG), despite longer maturation periods for AVF (2 to 4 months) and primary failure rates of 20% to 50%. 3,4 These facts often make tunneled catheters the 1st method of dialysis access for patients, particularly for those without medical care coverage and access to proper primary preventa- tive care. The rate of ESRD patients starting dialysis with a Supported in part by the Clinical and Translational Science Award (UL1TR 000439). The authors declare no conflicts of interest. * Corresponding author. Tel.: 11-216-844-4866; fax: 11-216-844-7716. E-mail address: vikram.kashyap@UHhospitals.org Manuscript received August 9, 2013; revised manuscript December 23, 2013 0002-9610/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2014.01.010 The American Journal of Surgery (2014) -, -–-