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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Clinical Outcomes of Arteriovenous Grafts Using the Superficial Vein versus Venae Comitantes as Venous Outflow

Yo Seb Lee , M.D., Song Am Lee , M.D., Jae Joon Hwang , M.D., Jun Seok Kim , M.D., Ph.D., Hyun Keun Chee , M.D.

Department of Thoracic and Cardiovascular Surgery, Konkuk Medical Center, Konkuk University School of Medicine, Seoul, Korea

Correspondence to:Song Am Lee
Tel 82-2-2030-7594
Fax 82-2-2030-5039
E-mail azzy@kuh.ac.kr
ORCID
https://orcid.org/0000-0002-2218-5849

Received: September 1, 2023; Revised: December 5, 2023; Accepted: December 12, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes.
Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed.
Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs. group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups.
Conclusion: Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Keywords: Arteriovenous fistula, Graft, Vein, Hemodialysis, Chronic kidney failure

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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Clinical Outcomes of Arteriovenous Grafts Using the Superficial Vein versus Venae Comitantes as Venous Outflow

Yo Seb Lee , M.D., Song Am Lee , M.D., Jae Joon Hwang , M.D., Jun Seok Kim , M.D., Ph.D., Hyun Keun Chee , M.D.

Department of Thoracic and Cardiovascular Surgery, Konkuk Medical Center, Konkuk University School of Medicine, Seoul, Korea

Correspondence to:Song Am Lee
Tel 82-2-2030-7594
Fax 82-2-2030-5039
E-mail azzy@kuh.ac.kr
ORCID
https://orcid.org/0000-0002-2218-5849

Received: September 1, 2023; Revised: December 5, 2023; Accepted: December 12, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes.
Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed.
Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs. group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups.
Conclusion: Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Keywords: Arteriovenous fistula, Graft, Vein, Hemodialysis, Chronic kidney failure

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