Influencing factors of primary patency time and short-term patency rate of upper extremity arteriovenous graft

Objective  To explore the possible factors affecting the short-term patency of upper extremity arteriovenous graft （AVG）.

Methods  The maintenance hemodialysis patients who established upper extremity AVG in Qingyuan People's Hospital from January 2015 to June 2021 were retrospectively screened. Clinical data of patients were collected, and Kaplan-Meier survival analysis, Cox risk regression analysis, and Logistic regression analysis were used to explore possible factors affecting the primary patency time and the primary patency rate at 1 year after AVG.

Results  A total of 163 patients who met the screening requirements were included in this study. Kaplan-Meier survival analysis showed that the primary patency rates at 3 months, 6 months, and 12 months after AVG were 93.9%, 90.2%, and 81.6%, respectively. Compared with the brachial artery and the median cubital vein as the anastomotic vessels, the AVG established with the brachial artery and the basilic vein as the anastomotic vessels had a higher risk of dysfunction （Log-rank χ²=8.302, P=0.004）; Patients with a history of ipsilateral AVF occlusion had a higher risk of AVG dysfunction than those without a history of AVF occlusion （Log-rank χ²=6.387, P=0.011）; patients taking maintenance antiplatelet drugs had a lower risk of AVG dysfunction than that in patients not taking antiplatelet drugs （Log-rank χ²=4.952, P=0.026）. Univariate Cox risk regression analysis showed that platelet ratio （HR = 0.022, 95%CI 0.000～1.298, P=0.066）, C-reactive protein （HR=1.010, 95%CI 1.003～1.017, P=0.004） were Possible factors affecting primary patency time after AVG. Multivariate Cox risk regression model showed history of ipsilateral AVF occlusion （HR=1.913, 95%CI 1.071～3.419, P= =0.028）, C-reactive protein （HR=1.008, 95%CI 1.002～1.015, P= 0.012） were independent risk factors affecting the primary patency time after AVG. Multivariate Logistic stepwise regression analysis showed brachial artery diameter （OR = 3.721, 95%CI: 1.552～8.922, P = 0.003）, use of antiplatelet drugs （OR = 7.438, 95%CI: 1.367～40.470, P＜0.020） , history of ipsilateral AVF occlusion （OR = 0.061, 95%CI: 0.015～0.246, P＜0.001）, brachial artery and basilic vein as anastomotic vessel （OR=0.205, 95%CI 0.060～0.696, P=0.011） and C-reactive protein level （OR=0.970, 95%CI 0.949～0.990, P=0.004） were independent factors affecting the primary patency rate at 1 year after AVG.

Conclusion  The history of ipsilateral AVF occlusion was an independent risk factor for primary patency time and short-term patency rate after AVG. Higher C-reactive protein level was an unfavorable factor for short-term patency after AVG. The use of antiplatelet drugs after AVG might be beneficial for AVG to maintain patency in the short term.