Comparison of Outcomes between Upper Arm Loop and Straight Arteriovenous Grafts in Hemodialysis Patients
Nutvara Deeratanasrikul, MD¹, Saritphat Orrapin, MD¹, Thoetphum Benyakorn, MD¹, Boonying Siribumrungwong, MD, PhD¹
Affiliation : ¹ Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
Objective: The effectiveness of different configurations of upper arm arteriovenous grafts (AVGs) in hemodialysis remains controversial. This study aimed to compare outcomes between upper arm straight AVGs (AS-AVG) and loop AVGs (AL-AVG).
Materials and Methods: A retrospective study included all upper arm AVGs performed for hemodialysis between January 2018 and December 2022. An AS-AVG was selected if the cubital brachial artery diameter was greater than 4 mm; otherwise, an AL-AVG was chosen. Postoperative and long-term complications, as well as primary patency, were compared between the two groups. Multivariable regression analyses were used to account for potential confounding factors due to imbalanced baseline characteristics.
Results: Two hundred eleven patients were included, with 127 (60%) receiving AS-AVGs and 84 (40%) receiving AL-AVGs. Baseline characteristics were not significantly different between the groups, except for a high proportion of males in AS-AVG (37% versus 57%, p=0.003). The rates of postoperative and long-term complications (i.e., infection, stenosis, thrombosis, and hemodialysis access-induced distal ischemia) were not significantly different between the groups. The primary patency rates were also comparable. The 1-year primary patency is 67% (95% CI 53 to 77) for AL-AVG and 73% (95% CI 62 to 81) for AS-AVG. However, the operation time for AL-AVG was significantly longer, taking approximately 15 minutes (95% CI 8 to 22, p<0.001) more than AS-AVG.
Conclusion: The outcomes between AS-AVG and AL-AVG are not significantly different in terms of effectiveness and safety. Further study is needed to confirm the results. This conclusion specifically applies to patients with a cubital brachial artery diameter greater than 4 mm, indicating that both graft types may be viable options.
Received 28 November 2025 | Revised 18 February 2026 | Accepted 20 February 2026
DOI: 10.35755/jmedassocthai.2026.5.03898
Keywords : Hemodialysis; Arteriovenous graft; Patency; Configuration; Loop; Straight; Ischemia
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