Assessing Time to Removal of Tunneled Dialysis Catheters After Arteriovenous Access Creation
Anna Kobzeva-Herzog*, Scott Levin, Sara Young, Thomas McNamara, Andrea Alonso, Alik Farber, Elizabeth King, Jeffrey J. Siracuse
Vascular Surgery, Boston University Medical Center, Boston, MA
Objective: Tunneled dialysis catheters (TDCs) are a temporary bridge until definitive AV access. Our objective was to evaluate the time to tunneled dialysis catheter (TDC) removal in patients who received arteriovenous (AV) access.
Design: A single center retrospective cohort study.
Setting: A tertiary-care, urban, safety-net hospital.
Patients: All patients with TDCs who underwent AV access creation from 2014-2020.
Intervention: There was no intervention.
Main Outcome Measure: Primary outcome was time to TDC removal after AV access creation.
Results: There were 364 patients with AV access creations with TDCs in place. Average age was 58 years, 56% were male gender, and 64% were Black. Median time to TDC removal was 113 days (range, 22-931 days) with 71.4% having a TDC > 90 days after access creation. Patients with TDC > 90 days were often older (60 vs 54.7), had hypertension (98.1% vs 93.3%), were diabetic (65.4% vs 47.1%), and had longer average time to maturation (107.1 vs 55.4 days, P<.001) and first use (114 vs 59.4 days, P<.001). In Table 1, multivariable analysis showed that prosthetic graft use was less often associated with prolonged TDC use (OR .09 95% CI .04-.23, P=.003) and older age was associated with prolonged TDC use (OR 1.03, 95% CI 1.01-1.05, P=.005). Kaplan-Meier analysis showed that 87% of TDCs were removed at one year.
Conclusions: The majority of patients with TDCs who underwent AV access creation had prolonged TDC use. Prosthetic graft use was associated with shorter catheter times. Our finding may relate to the shorter time to use of graft compared with autogenous access. However, when considering graft versus autogenous access, surgeons should weigh the previously shown occlusion and infection risks of graft access against the risk of TDC complications.
Multivariable Logistic Regression of TDC Removal > 90 Days
|Variable||Odds Ratio||95% Confidence Interval||P-value|
|Independent Ambulatory Status||1.38||0.71-2.67||0.34|
|Peripheral Arterial Disease||1.29||0.62-2.70||0.50|
|Congestive Heart Failure||1.60||0.89-2.89||0.12|
|Diabetes (Type I or Type II)||1.49||0.83-2.66||0.18|
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