Upper-arm PTFE arteriovenous grafts in hemodialysis: Patency, predictors, and angioplasty salvage

Aim: Arteriovenous grafts (AVGs) are an essential dialysis access option for patients unsuitable for autogenous fistula creation. We evaluated patency, predictors of patency loss, infection outcomes, and balloon angioplasty salvage of upper-arm polytetrafluoroethylene (PTFE) AVGs in a high-risk hemodialysis cohort.

Material and Methods: This retrospective single-center cohort study (January 2018 – December 2023) included 124 patients undergoing upper-arm straight PTFE AVG placement (brachial artery – axillary vein). The mean age was 59.1 ± 9.3 years; 74.2% had diabetes and 83.1% hypertension. Patency was estimated by Kaplan – Meier analysis and predictors of primary patency loss by multivariable Cox regression. Twenty-nine patients underwent balloon angioplasty after surgical embolectomy for post-anastomotic venous stenosis with thrombosis. Median follow-up was 11 months (IQR 7 – 16).

Results: Primary patency was 58% at 6 months and 46% at 12 months; secondary patency was 71% and 58%. On Cox regression, peripheral vascular disease (HR 2.05, p = 0.004) and diabetes (HR 1.75, p = 0.023) independently predicted patency loss. Infection occurred in 12 patients (9.7%); three required explantation, with no bacteremia or sepsis. Balloon angioplasty achieved technical success in 21/29 (72.4%). Mean reintervention rate was 1.6 procedures per year.

Conclusion: Upper-arm PTFE AVGs provide acceptable patency and manageable infection rates in high-risk hemodialysis patients. Timely angioplasty salvage extends secondary patency, supporting the continued role of AVGs when paired with structured surveillance and proactive endovascular management.