title: Graftula: a composite access consisting of a graft used to repair a dysfunctional hemodialysis fistula.
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.
authors.affiliation: Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramani
authors.forename: Ajay
authors.initials: A
authors.lastname: Kallam
authors.forename: Gazi
authors.initials: G
authors.lastname: Zibari
authors.forename: Gloria
authors.initials: G
authors.lastname: Caldito
authors.forename: Sunanda J
authors.initials: SJ
authors.lastname: Ram
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Abreo
authors.forename: Adrian
authors.initials: A
authors.lastname: Sequeira
mesh_terms: D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000601:surgery*