Endovascular interventions on intragraft stenosis in prosthetic hemodialysis grafts: predictors of patency

While endovascular outcomes on venous anastomosis and central venous stenoses interventions in hemodialysis access have been extensively studied, there is a paucity of data on intragraft stenoses. The purpose of this study was to determine predictors of patency after interventions on intragraft stenoses. Retrospective review of our procedural database for all percutaneous interventions on prosthetic AV grafts (AVG) presenting with a first-time intragraft stenosis revealed 186 unique AVGs (83 males, 103 females, mean age 59.7 years). Post-intervention access patency rates were calculated using Kaplan-Meier analysis. Predictors of success were assessed using the Cox proportional hazards multivariate analysis. A total of 231 first-time intragraft stenoses were identified in 186 unique AVGs. Graft thrombosis was present in 63%. The 6 month primary patency rate was 40%. At 12 months, the secondary patency rate was 67%. Multivariate analysis was performed on gender, age, AVG location, AVG age, presence of AVG thrombosis, number of intragraft stenoses, overall severity of intragraft stenoses, presence of a concurrent non-graft lesion within the access circuit, and treatment by angioplasty versus bailout stent deployment. Primary patency was negatively affected by presence of graft thrombosis (HR 1.43, p=0.048) and concurrent extragraft lesion (HR=1.51, p=0.047). Nonthrombosed grafts had a 6-month primary patency of 52%. Thrombosed grafts had a 3-month primary patency rate of 49%. Secondary patency was only affected by female patient gender (HR=1.58, p=0.029). The post-intervention patency rates for intragrafts stenosis fell within K/DOQI guideline target patency rates. Graft thrombosis, concurrent extragraft lesions, and gender were predictors of post-interventional patency rates.