Objective: This study aims to identify and analyze implications of COVID‐19 positivity on AVF occlusion, subsequent treatment patterns, and ESRD patient outcomes. Our aim is to provide a quantitative context for vascular access surgeons in order to optimize surgical decision making and minimize patient morbidity. Methods: The de-identified national TriNetX database was queried to extracted all adult patients who had a known AVF between January 1, 2020 and December 31, 2021. From this cohort individuals who also were diagnosed with COVID‐19 prior to creation of their AVF were identified. Cohorts were propensity score matched according to age at AVF surgery, gender, ethnicity, diabetes mellitus, nicotine dependence, tobacco use, use of anticoagulant medications, and use of platelet aggregation inhibitors, hypertensive diseases, hyperlipidemia, and prothrombotic states. Results: After propensity score matching there were 5170 patients; 2585 patients in each group. The total patient population had 3023 (58.5%) males and 2147 (41.5%) females. The overall rate of thrombosis of AV fistulas was 300 (11.6%) in the cohort with COVID‐19 and 256 (9.9%) in the control group (OR 1.199, CI 1.005-1.43, P =.0453). Open revisions of AVF with thrombectomy were significantly higher in the COVID‐19 cohort compared to the non-COVID‐19 group (1.5% vs .5% P = .0002, OR 3.199, CI 1.668-6.136). Regarding the time from AVF creation to intervention, the median days for open thrombectomy in COVID-19 patients was 72 vs 105 days in controls. For endovascular thrombectomy, the median was 175 vs 168 days for the COVID-19 and control cohorts respectively. Conclusion: As for this study, there were significant differences in rates of thrombosis and open revisions of recent created AVF, however endovascular interventions remained remarkably low. As noted in this study, the persistent prothrombotic state of patients with a history of COVID‐19 may persist beyond the acute infectious period of the disease.
SantoroDBenedettoFMondelloP, et al.Vascular access for hemodialysis: Current perspectives. Int J Nephrol Renovasc Dis. 2014;7:281-294. doi:10.2147/IJNRD.S46643.
2.
ShiJYanJJChenJ, et al.The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study. J Vasc Access. 2021;22(2):280-287. doi:10.1177/1129729820937484.
3.
HilbrandsLBDuivenvoordenRVartP, et al.COVID-19-related mortality in kidney transplant and dialysis patients: Results of the ERACODA collaboration. Nephrol Dial Transplant. 2020;35(11):1973-1983. doi:10.1093/ndt/gfaa261.
4.
JagerKJKramerAChesnayeNC, et al.Results from the ERA-EDTA registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney Int. 2020;98(6):1540-1548. doi:10.1016/j.kint.2020.09.006.
5.
IzcovichARagusaMATortosaF, et al.Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15(11):e0241955. doi:10.1371/journal.pone.0241955.
6.
SeetCLindseyBSivaprakasamR, et al.The management of dialysis access thrombosis during the COVID-19 pandemic. J Vasc Access. 2021;2021:112972982110455. doi:10.1177/11297298211045578.
7.
ValeriAMRobbins-JuarezSYStevensJS, et al.Presentation and outcomes of patients with ESKD and COVID-19. J Am Soc Nephrol. 2020;31(7):1409-1415. doi:10.1681/ASN.2020040470.
8.
FisherMYunesMMokrzyckiMHGolestanehLAlahiriECocoM. Chronic hemodialysis patients hospitalized with COVID-19: Short-term outcomes in the Bronx, New York. Kidney360. 2020;1(8):755-762. doi:10.34067/KID.0003672020.
9.
AckermannMVerledenSEKuehnelM, et al.Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120-128. doi:10.1056/NEJMoa2015432.
10.
AnkaAUTahirMIAbubakarSD, et al.Coronavirus disease 2019 (COVID-19): An overview of the immunopathology, serological diagnosis and management. Scand J Immunol. 2021;93(4):e12998. doi:10.1111/sji.12998.
11.
HanffTCMoharebAMGiriJCohenJBChirinosJA. Thrombosis in COVID-19. Am J Hematol. 2020;95(12):1578-1589. doi:10.1002/ajh.25982.
12.
PiazzaGCampiaUHurwitzS, et al.Registry of arterial and venous thromboembolic complications in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2060-2072. doi:10.1016/j.jacc.2020.08.070.
13.
Al-JaishiAALiuARLokCEZhangJCMoistLM. Complications of the arteriovenous fistula: A systematic review. J Am Soc Nephrol. 2017;28(6):1839-1850. doi:10.1681/ASN.2016040412.
14.
BylsmaLCGageSMReichertHDahlSLMLawsonJH. Arteriovenous fistulae for haemodialysis: A systematic review and meta-analysis of efficacy and safety outcomes. Eur J Vasc Endovasc Surg. 2017;54(4):513-522. doi:10.1016/j.ejvs.2017.06.024.
15.
DesbuissonsGMichonAAttiasP, et al.Arteriovenous fistulas thrombosis in hemodialysis patients with COVID-19. J Vasc Access. 2022;23:412-415. doi:10.1177/1129729821996091.
16.
GirerdSGirerdNFrimatL, et al.Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial. Clin Kidney J. 2020;13(1):116-122. doi:10.1093/ckj/sfz048.
17.
OuyangJBajracharyaSJohnS, et al.Clotting of hemodialysis access in patients with COVID-19 in an inner-city hospital. Nephron. 2022;146:179-184. doi:10.1159/000520174.
18.
KhooBZELimRSSeeYPYeoSC. Dialysis circuit clotting in critically ill patients with COVID-19 infection. BMC Nephrol. 2021;22(1):141. doi:10.1186/s12882-021-02357-3.
19.
TeixeiraJPCombsSAOwenJG. Recurrent thrombosis of an arteriovenous fistula as a complication of COVID-19 in a chronic hemodialysis patient: A case report. J Vasc Access. 2022;23:636-639. doi:10.1177/11297298211000881.
20.
CombeCBasileCLomonteC, et al.A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic. J Nephrol. 2021;34(2):365-368. doi:10.1007/s40620-021-01002-4.
