Results of Aggressive Graft Surveillance and Endovascular Treatment on Secondary Patency Rates of Upper Extremity Vectra Vascular Access Grafts and Transposed Basilic Veins

Stavros K. Kakkos, MD, PhD, Tanja Andrzejewski, MD, Joseph A. Haddad, Georges K. Haddad, MD, FACS, RVT, Daniel J. Reddy, MD, FACS, RVT, Timothy J. Nypaver, MD, RVT, Judith C. Lin, MD, RVT, Alexander D. Shepard, MD, RVT, Mitchell Weaver, MD, RVT.
Henry Ford Hospital, Detroit, MI, USA.

Objectives: To compare patency rates of the Vectra^® Graft with the transposed basilic vein (TBV).
Methods: Seventy-six patients had a straight upper arm Vectra^® Vascular Access Graft (C. R. Bard, Inc., Murray Hill, NJ) placed, while in 41 patients basilic vein transposition was performed. Graft surveillance criteria included clinical and hemodialysis parameters to detect a failing/failed access, followed by endovascular treatment - rheolytic thrombectomy (AngioJet, Possis Medical) and/or angioplasty of the responsible anatomical lesion(s).
Results: Use of Vectra grafts and TBVs started after a median of 14 and 70 days, respectively (p<0.001). TBVs were complicated by steal syndrome in 13.2%, compared to 0% with the Vectra graft (p=0.005). Patency results are shown in the Table. Thrombectomy was performed in 25 grafts and 5 TBVs (p=0.014); isolated angioplasty, not associated with thrombosis, was performed in 25 grafts and 19 TBVs (p=0.15). These interventions provided an equivalent secondary patency rate at 12 and 18 months. This patency rate equivalency was present despite the necessity of graft removal for infection in five Vectra grafts (Figure).
Conclusions: Aggressive graft surveillance and endovascular treatment methods can yield equivalent long-term patency rates between Vectra graft and TBV. Longer follow-up will determine the effectiveness of this policy.

**Primary patency (PP), secondary patency (SP) and total usage rate at 12 and 18 months**
	PP 12 months	PP 18 months	SP 12 months	SP 18 months	Total usage rate 12 months	Total usage rate 18 months
TBV	82.1%	77.8%	88.2%	88.2%	88.2%	88.2%
Vectra graft	70.4%	57.8%	88.2%	83.8%	81%	78.1%
p		0.033		p=0.91		p=0.31

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