Long-Term Outcomes and Influencing Factors of Lower Extremity Arteriovenous Grafts in Hemodialysis Patients: A Single-Center Retrospective Study

Long-Term Outcomes and Influencing Factors of Lower Extremity Arteriovenous Grafts in Hemodialysis Patients: A Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Outcomes and Influencing Factors of Lower Extremity Arteriovenous Grafts in Hemodialysis Patients: A Single-Center Retrospective Study Jian Shen, Mengting Liu, Mingxi Lu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7210120/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Oct, 2025 Read the published version in BMC Nephrology → Version 1 posted 13 You are reading this latest preprint version Abstract Objective : To investigate the long-term outcomes and influencing factors of lower extremity arteriovenous grafts (AVGs) in maintenance hemodialysis patients. Methods : A retrospective analysis was conducted on clinical data from 96 hemodialysis patients who underwent lower extremity arteriovenous graft placement at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2013 and December 2023. Demographic characteristics, laboratory parameters, surgical details, and follow-up outcomes were recorded. Kaplan‒Meier analysis was used to assess patency rates, whereas univariate and multivariate Cox regression models were used to identify predictors of thrombosis and graft failure. The outcomeswere defined according to the Society for Vascular Surgery reporting standards. Results : The cohort had a mean age of 61.3 ± 12.5 years, with 67 females (69.8%) and a mean duration of dialysis of 6.2 ± 4.5 years. The procedureswere predominantly left-sided (65.6%), with superficial femoral artery anastomosis (47.9%). The primarypatency rates were 29.2% ± 4.6%, 13.3% ± 3.5%, and 8.9% ± 2.9% at 1, 2, and 3 years, respectively (mean 11.9 ± 13.5 months). The assisted primary patency rates reached 90.3% ± 3.1%, 72.2% ± 4.7%, and 64.6% ± 5.2% (mean 22.2 ± 17.0 months), whereas the secondary patency rates were 94.8% ± 2.3%, 94.8% ± 2.3%, and 88.3% ± 3.5% (mean 52.8 ± 31.8 months). No significant differences were observed across arterial anastomosis types (P > 0.05). The thrombosis rate was 0.20 events per patient-year, with a mean time to first thrombosis of 20.5 ± 14.0 months. An elevated monocyte count was a protective factor against thrombosis (HR 0.469, 95% CI 0.232–0.946). Prior arteriovenous fistula history reduced the risk of graft abandonment (HR 0.258, 95% CI 0.083–0.806), whereas a BMI >24 kg/m² increased therisk of abandonment (HR 3.970, 95% CI 1.482–10.636). Conclusions : Lower extremity arteriovenous grafts demonstrate superior secondary patency rates, independent of arterial anastomosis selection. These grafts represent a viable option for patients with upper extremity central venous stenosis, exhausted vascular access, or hemodynamic instability. Clinical trial: Chinese Clinical Trial Registry (ChiCTR), MR-33-25-018188, Retrospectively Registered, Date: 2025-3-4 Arteriovenous graft Renal dialysis Lower extremity Patency rates Vascular access Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Oct, 2025 Read the published version in BMC Nephrology → Version 1 posted Editorial decision: Revision requested 29 Aug, 2025 Reviews received at journal 27 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviews received at journal 15 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviews received at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers invited by journal 10 Aug, 2025 Editor invited by journal 01 Aug, 2025 Editor assigned by journal 30 Jul, 2025 Submission checks completed at journal 30 Jul, 2025 First submitted to journal 24 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7210120","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500205483,"identity":"445454d9-fe1f-4c67-9603-a3f3ea0e964c","order_by":0,"name":"Jian Shen","email":"","orcid":"","institution":"Yuyao People’s Hospital of Zhejiang Province","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Shen","suffix":""},{"id":500205484,"identity":"a1394104-1829-4f98-9d99-8aa4903c3520","order_by":1,"name":"Mengting Liu","email":"","orcid":"","institution":"Sir Run Run Shaw Hospital, Alaer Hospital,","correspondingAuthor":false,"prefix":"","firstName":"Mengting","middleName":"","lastName":"Liu","suffix":""},{"id":500205485,"identity":"b788a58d-8c5a-4715-9a17-c1886a49a542","order_by":2,"name":"Mingxi Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACPiA+AMQ8/AwMCUCambAWNpgWyQZStICBwQEwRYwWiezEwwW/DssYnz/wTIKhwjqxgf3sAQJacjccntmXxmN24ECaBMOZ9MQGnrwEwlp4e2x4zA42pEkwth1ObJDgMSBGiwSPcTMDUMs/YrXw/LDhMWADaWkgRgvPW6AtDWk8EmcYki0SjqUbt/Hk4NfCz567+TPPn8P2/P1nEm98qLGW7Wc/g18LGDC2gUieBHBksuFXCwN/QAT7AeIUj4JRMApGwYgDAAWzQIHT+1gOAAAAAElFTkSuQmCC","orcid":"","institution":"Sir Run Run Shaw Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mingxi","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2025-07-25 04:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7210120/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7210120/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-025-04505-5","type":"published","date":"2025-10-30T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95039910,"identity":"e1b464b9-cedd-4583-abc3-cadb40d8d749","added_by":"auto","created_at":"2025-11-03 16:05:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":510114,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptFile.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7210120/v1_covered_8e9067b2-2be0-41cb-bf32-f16f72784256.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-Term Outcomes and Influencing Factors of Lower Extremity Arteriovenous Grafts in Hemodialysis Patients: A Single-Center Retrospective Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Arteriovenous graft, Renal dialysis, Lower extremity, Patency rates, Vascular access","lastPublishedDoi":"10.21203/rs.3.rs-7210120/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7210120/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To investigate the long-term outcomes and influencing factors of lower extremity arteriovenous grafts (AVGs) in maintenance hemodialysis patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective analysis was conducted on clinical data from 96 hemodialysis patients who underwent lower extremity arteriovenous graft placement at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2013 and December 2023. Demographic characteristics, laboratory parameters, surgical details, and follow-up outcomes were recorded. Kaplan‒Meier analysis was used to assess patency rates, whereas univariate and multivariate Cox regression models were used to identify predictors of thrombosis and graft failure. The outcomeswere defined according to the Society for Vascular Surgery reporting standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The cohort had a mean age of 61.3 ± 12.5 years, with 67 females (69.8%) and a mean duration of dialysis of 6.2 ± 4.5 years. The procedureswere predominantly left-sided (65.6%), with superficial femoral artery anastomosis (47.9%). The primarypatency rates were 29.2% ± 4.6%, 13.3% ± 3.5%, and 8.9% ± 2.9% at 1, 2, and 3 years, respectively (mean 11.9 ± 13.5 months). The assisted primary patency rates reached 90.3% ± 3.1%, 72.2% ± 4.7%, and 64.6% ± 5.2% (mean 22.2 ± 17.0 months), whereas the secondary patency rates were 94.8% ± 2.3%, 94.8% ± 2.3%, and 88.3% ± 3.5% (mean 52.8 ± 31.8 months). No significant differences were observed across arterial anastomosis types (P \u0026gt; 0.05). The thrombosis rate was 0.20 events per patient-year, with a mean time to first thrombosis of 20.5 ± 14.0 months. An elevated monocyte count was a protective factor against thrombosis (HR 0.469, 95% CI 0.232–0.946). Prior arteriovenous fistula history reduced the risk of graft abandonment (HR 0.258, 95% CI 0.083–0.806), whereas a BMI \u0026gt;24 kg/m² increased therisk of abandonment (HR 3.970, 95% CI 1.482–10.636).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Lower extremity arteriovenous grafts demonstrate superior secondary patency rates, independent of arterial anastomosis selection. These grafts represent a viable option for patients with upper extremity central venous stenosis, exhausted vascular access, or hemodynamic instability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial: \u003c/strong\u003eChinese Clinical Trial Registry (ChiCTR), MR-33-25-018188, Retrospectively Registered, Date: 2025-3-4\u003c/p\u003e","manuscriptTitle":"Long-Term Outcomes and Influencing Factors of Lower Extremity Arteriovenous Grafts in Hemodialysis Patients: A Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-14 16:11:31","doi":"10.21203/rs.3.rs-7210120/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-29T07:17:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T11:26:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191938228243784725334170811924750293390","date":"2025-08-19T05:55:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T12:15:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77766148826161586744434055332821875501","date":"2025-08-13T23:58:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156410785083536002490845978954603387261","date":"2025-08-13T05:48:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-11T23:29:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278559020511821890347590366052342255762","date":"2025-08-11T22:44:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-10T09:27:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-01T12:32:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T07:38:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T07:37:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2025-07-25T03:54:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9722e885-95a7-40a9-bbb4-cdff6eddaa92","owner":[],"postedDate":"August 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:00:11+00:00","versionOfRecord":{"articleIdentity":"rs-7210120","link":"https://doi.org/10.1186/s12882-025-04505-5","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2025-10-30 15:57:11","publishedOnDateReadable":"October 30th, 2025"},"versionCreatedAt":"2025-08-14 16:11:31","video":"","vorDoi":"10.1186/s12882-025-04505-5","vorDoiUrl":"https://doi.org/10.1186/s12882-025-04505-5","workflowStages":[]},"version":"v1","identity":"rs-7210120","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7210120","identity":"rs-7210120","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}