Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula |
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| Authors: | Karthik Ramani Ajay Kallam Gazi Zibari Gloria Caldito Sunanda J. Ram Kenneth D. Abreo Adrian Sequeira |
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| Affiliation: | 1. Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio;2. Interventional Nephrology Section, Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana;3. Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana;4. Department of Biometrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana |
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| Abstract: | Nonmaturing or dysfunctional hemodialysis fistulas are often repaired with interposition grafts placed either within the fistula (fistula‐to‐fistula configuration), or connected to another vein (fistula‐to‐vein configuration). The goal of this study was to compare the survival and usefulness of the composite accesses thus created, which we call “graftulas,” with upperarm grafts. This was a retrospective study wherein we determined the survival and thrombosis rates of graftulas (n = 24) and upper arm grafts (n = 31) placed 1/1/07 through 12/31/09 and followed through 11/30/10. Graftulas resembled grafts as most (96%) were successfully cannulated in 65 ± 43 days. Survival of graftulas was also similar to grafts (58%, 47%, and 32% vs. 56%, 47%, and 39% at 1, 2, and 3 years respectively, p = 0.60). However, graftulas had a lower thrombosis rate than grafts (0.5 vs. 1.2 per patient year, p = 0.04), and in the fistula‐to‐fistula configuration, a 2‐year thrombosis‐free survival of 78%. Total survival of the access site (fistula + graftula) was 92%, 73%, and 42% at 1, 3, and 5 years, respectively. Graftulas possess certain beneficial properties of fistulas and grafts that allows for continued use of the original access site. |
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