PROLONGATION OF HEMODIALYSIS ACCESS SURVIVAL WITH ELECTIVE REVISION

153 hemodialysis accesses (56 fistulas and 97 PTFE grafts) were follow ed from placement to see if elective intervention prolonged access sur vival. The mean follow-up was 772 days (minimum 14 days, maximum 2755 days). Patients who expired, were transplanted or transferred were exc luded. The groups of fistulas and grafts were subdivided into those wh ose first intervention was an episode of clotting versus those whose f irst intervention was an elective revision (either surgical repair or angioplasty of an area of stenosis within the access or run-off). Thes e groups were compared to see whether electively revising an access pr ior to clotting would change the ultimate longevity of the access when compared to repairing the access after clotting. PTFE grafts with an initial elective intervention had an improved survival compared to gra fts that clotted first (1023 days vs 689 days, p = 0.01). The elective ly revised grafts had fewer subsequent clotting episodes (1.1 clots pe r patient year vs 3.6, p = 0.02) and fewer interventions (1.8 interven tions per patient year vs 3.7, p = 0.06). In fistulas, an initial elec tive revision increased access longevity when compared to repair after the fistula clotted (999 days vs 358 days, p = 0.005). Clotting episo des were decreased in those electively revised (0.5 clots per patient year vs 4.8, p = 0.014). Total interventions per patient year were als o lower in those electively revised (1.2 vs 5.3, p = 0.028). In conclu sion, elective correction of abnormalities in PTFE grafts and in AV fi stulas prolongs access life when compared to repair after an initial e pisode of clotting. Elective revision also decreased the subsequent nu mber of clotting episodes per patient year and the total number of int erventions (revisions and declottings) per patient year in both grafts and fistulas.