Hybrid arteriovenous grafts for hemodialysis access: A 10-year single-centre experience with off-the-shelf stent-graft configurations

Abstract

Introduction:

Hybrid arteriovenous grafts (AVGs) incorporating a stented venous outflow were developed to facilitate access creation in patients with unfavorable venous anatomy. Following discontinuation of dedicated hybrid graft devices, off-the-shelf (OTS) stent-graft configurations have been adopted. We report our 10-year institutional experience and evaluate patency outcomes and reintervention burden.

Methods:

A retrospective review of consecutive hybrid AVGs created between 2014 and 2024 was performed. Patients were stratified by configuration: dedicated Gore Hybrid Vascular Graft (GHVG) versus OTS graft plus covered stent. Primary, assisted primary, and secondary patency were calculated using Kaplan–Meier analysis. Reinterventions were analyzed descriptively and expressed per patient-year.

Results:

Forty hybrid AVGs were created (GHVG, 7 (17.5%); OTS, 33 (82.5%)). Median follow-up was 37.3 months. Primary patency was 50.7% at 6 months and 31.0% at 12 months (median 6.4 months). Assisted primary patency was 68.8% at 6 months and 52.3% at 12 months (median 12.1 months). Secondary patency was 89.3% at 12 months and 83.6% at 24 months (median 71.2 months). A total of 172 reinterventions were performed (1.30 per patient-year). The most frequent lesions were venous stent-edge and cannulation-site stenoses. No statistically significant difference in patency was observed between GHVG and OTS configurations.

Conclusions:

Hybrid AVG construction provides durable secondary patency despite limited primary patency, with an acceptable reintervention burden. Off-the-shelf configurations demonstrate outcomes comparable to dedicated hybrid devices and represent a practical option for patients with complex venous outflow anatomy.