Abandonment of Arteriovenous Access Is Common

Access abandonment after arteriovenous (AV) fistula (AVF) or graft (AVG) creation can pose clinical challenges for patients with end-stage renal disease. Our objective was to track AV access abandonment and identify factors that affect its rate. A single institutional database was queried for all AVF/AVG creations from 2014 to 2020. Demographics, comorbidities, and outcomes were collected. Access abandonment was defined as an AV access that was no longer used in patients with established alternate hemodialysis methods. Risk factors and downstream effects of access abandonment were analyzed. There were 678 patients with AV access with a mean age of 59.6 years; 41.4% were female. Cases included 295 (43.5%) brachiocephalic, 170 (25.1%) brachiobasilic, 101 (14.9%) radiocephalic, and 41 (6%) forearm AVFs. Prosthetic AVGs were used in 14.2% of cases. Tunneled dialysis catheters were present at the time of AV access creation in 58.1% of cases. There were 180 (26.5%) accesses abandoned throughout the study period; of these, 45% never matured, 61% required reinterventions, and 96% lost primary patency. Access abandonment occurred more often in patients with prior access (20% vs 12.7%), radiocephalic AVFs (19.4% vs 13.3%), and forearm grafts (5% vs 1.2%), and less often with brachiocephalic AVFs (36.7% vs 46%) (all P < .05). Freedom from access abandonment/death at 1 and 5 years was 49% and 7%, respectively. Survival at 1 and 5 years was 94% and 66%, respectively, with no difference seen in patients with/without abandoned access during this period. Access abandonment/death at 5 years was associated with radiocephalic AVF creation (hazard ratio [HR]: 1.27, 95% confidence interval [CI]: 1.02-1.58; P = .04) and chronic obstructive pulmonary disease (HR: 1.36, 95% CI: 1.03-1.81, P = .03). Access abandonment did not affect 5-year survival; however, congestive heart failure (HR: 2.18, 95% CI: 1.4-3.41), prior AV access (HR: 1.77, 95% CI: 1.08-2.89), and age (HR: 1.05, 95% CI: 1.03-1.07) were associated with increased mortality (all P < .05). AV access-site abandonment was high in frequency with few AVFs/AVGs being used at 5 years. Radiocephalic AVFs were more likely to be abandoned. Access abandonment did not affect long-term survival.