Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula

Authors

  • Karthik Ramani,

    1. Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio
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  • Ajay Kallam,

    1. Interventional Nephrology Section, Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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  • Gazi Zibari,

    1. Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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  • Gloria Caldito,

    1. Department of Biometrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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  • Sunanda J. Ram,

    1. Interventional Nephrology Section, Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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  • Kenneth D. Abreo,

    1. Interventional Nephrology Section, Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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  • Adrian Sequeira

    1. Interventional Nephrology Section, Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Address correspondence to: Adrian Sequeira, M.D., Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, Tel.: 318-675-7402, Fax: 318-675-5913, or e-mail: aseque@lsuhsc.edu.

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 (= 24) and upper arm grafts (= 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, = 0.60). However, graftulas had a lower thrombosis rate than grafts (0.5 vs. 1.2 per patient year, = 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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