Impact of evolving strategies for arteriovenous graft creation and management on patency outcomes.

Background: Arteriovenous grafts (AVGs) are essential alternatives for hemodialysis patients who are unsuitable for arteriovenous fistulas (AVFs). As surgical expertise and monitoring strategies evolve, understanding the long-term performance and influencing factors of AVGs is crucial.

Methods: This retrospective study analyzed 980 patients who underwent AVG creation at a single center between 2014 and 2022. Patients were grouped into three periods based on practice evolution. Primary and secondary patency rates at 6, 12, and 24 months were assessed via Kaplan-Meier's analysis, and Cox regression was used to identify independent predictors of secondary patency.

Results: Nine hundred and eighty patients were included (period I: 110; period II: 379; period III: 491). Over time, significant changes were noted in graft type selection (standard to Intering), anastomosis site (from antecubital to basilic vein), and adoption of endovascular interventions. Secondary patency rates significantly improved from period I to III (log-rank  < 0.001). Cox regression analysis identified risk factors for standard grafts, antecubital and brachial vein anastomosis, intervention count, and thrombosis.

Conclusions: Over nine years, procedural refinements and enhanced surveillance strategies have significantly improved AVG outcomes, particularly secondary patency. These findings support the growing role of AVGs as a reliable and sustainable vascular access option for hemodialysis patients.