011 - Open Revision Compared to Endovascular Intervention in Failed Hemodialysis Vascular Access: A NSPQI Project Study
Osman Ahmed, Doctor of Medicine – Assistant Professor, Department of Interventional Radiology, University of Chicago
Purpose: To identify the variables associated with reintervention using vascular open revision vs endovascular intervention in patients with arteriovenous fistulas (AVFs) and grafts (AVGs).
Material and Methods: The 2017-2020 American College of Surgeons National Surgical Quality Improvement Program database was queried for reintervention of AVFs and AVGs using endovascular intervention (declot, angioplasty, and stenting) and vascular open revision. The main outcome variable of interest was the type of reintervention. Multivariable logistic regression was performed to assess the variables associated with open revision compared to endovascular intervention.
Results: A total of 791 patients met the inclusion criteria, of which 159 (20.1%) required endovascular intervention and 632 (79.9%) required open reintervention. Multivariable regression revealed that age (odds ratio [OR]: 1.00; 95% confidence interval [CI]: 0.99-1.01; P = 1.00), male sex (OR: 0.67; 95% CI: 0.46-0.97; P = 0.036), Asian (OR: 1.10; 95% CI: 0.24-5.17; P = 0.90), Black or African American (OR: 1.12; 95% Cl: 0.30-4.25; P = 0.87), Native Hawaiian or Other Pacific Islander (OR: 0.75; 95% CI: 0.054-10.3; P = 0.83), Native Hawaiian or Pacific Islander (OR: 0.73; 95% CI: 0.12-4.58; P = 0.73), White (OR: 0.95; 95% CI: 0.25-3.54, P = 0.94), and open wound/ wound infection (OR: 0.73; 95% CI: 0.45-1.18; P = 0.20).
Conclusions: The odds of patients requiring a vascular open revision of their AVF/AVGs as opposed to an endovascular declot is 33% lower for males when compared to females. It is important to have a multidisciplinary approach for failed dialysis accesses, involving vascular surgeons and interventional radiologists, as it is difficult to identify variables associated with open revision compared to endovascular intervention.