The United Kingdom and Ireland experience of the Haemodialysis Reliable Outflow graft for vascular access

James P. Hunter, Simon R. Knight, N. Inston, D. Ridway, A. Tavakoli, S. Suttie, D. Kingsmore, T. Brown, S. Sultan, J. Gilbert

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    Abstract

    Objectives: To describe the UK and Ireland experience of the Haemodialysis Reliable Outflow graft in complex vascular access.

    Design: Observational, multi-centre case series.

    Methods: Data from any patient undergoing Haemodialysis Reliable Outflow graft were collected from eight UK and one Irish centre. Any Haemodialysis Reliable Outflow procedure between July 2013 and May 2016 was included. Demographics, primary and secondary patency rates, and complications were analysed.

    Results: A total of 52 patients underwent Haemodialysis Reliable Outflow graft insertion. Median age was 55 (20-86) years, 24 (46%) were male and 66% were Caucasian. Median follow-up was 290 (10-966) days and patient survival was 41/52 (79%). In total, 48 procedures were in the upper limb with 39 using the brachial artery as inflow (75%). The internal jugular vein and subclavian vein were most frequently used as access for outflow insertion. Primary patency rates at 6, 12, and 24 months were 51.2% (95% confidence interval, 38.8%-67.4%), 40.9% (95% confidence interval, 28.7%-58.2%), and 33.4% (95% confidence interval, 21.3%-52.5%), respectively. Secondary patency rates at 6, 12, and 24 months were 84.8% (95% confidence interval, 75%-95.9%), 76.5% (95% confidence interval, 64.5%-90.6%), and 70.6% (95% confidence interval, 56%-88.9%), respectively. There were 65 surgical and 49 radiological interventions resulting in 2.30 interventions per year to retain patency. Complications included four infections and two episodes of steal syndrome.

    Conclusion: The Haemodialysis Reliable Outflow graft provides acceptable 12-month secondary patency rates and acceptable complication rates in a UK and Ireland multi-centre series of complex access patients. Haemodialysis Reliable Outflow should be considered in patients with central pathology as a potential alternative to lower limb grafts and long-term central venous catheters.

    Original languageEnglish
    Pages (from-to)12-18
    Number of pages7
    JournalJournal of Vascular Access
    Volume20
    Issue number1
    Early online date22 Apr 2018
    DOIs
    Publication statusPublished - 1 Jan 2019

    Keywords

    • Vascular access
    • arteriovenous graft
    • central venous occlusion
    • complex vascular access
    • haemodialysis

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  • Cite this

    Hunter, J. P., Knight, S. R., Inston, N., Ridway, D., Tavakoli, A., Suttie, S., Kingsmore, D., Brown, T., Sultan, S., & Gilbert, J. (2019). The United Kingdom and Ireland experience of the Haemodialysis Reliable Outflow graft for vascular access. Journal of Vascular Access, 20(1), 12-18. https://doi.org/10.1177/1129729818770588