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NDT Advance Access published online on July 27, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh414
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received April 12, 2004
Accepted June 18, 2004

Original Article

Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients

Mark E. Lockhart 1*, Michelle L. Robbin 1, Michelle M. McNamara 1, Michael Allon 2

1 Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
2 Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

* To whom correspondence should be addressed. E-mail: mlockhart{at}uabmc.edu.



  Abstract

Background. Arterial calcification is a common problem in patients with chronic kidney disease, and has been associated with adverse clinical outcomes. The goal of the present study was to evaluate whether pelvic artery calcifications are associated with technical failure of arteriovenous thigh grafts in haemodialysis patients.

Methods. From 1 January 1999 to 30 June 2002, thigh grafts were placed in 54 haemodialysis patients who had exhausted all options for permanent vascular access in the upper extremities. Perioperative computed tomography (CT) of the abdomen and pelvis was obtained in 32 of the patients for diagnostic purposes unrelated to vascular access planning. Two radiologists, who were blinded to the graft outcomes, scored the vascular calcifications on CT of the distal aorta, common iliac, external iliac and common femoral arteries on a semi-quantitative 5-point scale. The association between technical graft failure (inability to complete the anastomosis) and the vascular calcification score was analysed.

Results. There was a high inter-observer agreement in scoring vascular calcification ({kappa} = 0.801). Among 26 patients with absent or mild pelvic arterial calcifications (grade 1-2) on CT, none (0%) experienced technical graft failure. In contrast, three of six patients (50%) with moderate to severe calcification (grade 3-5) had technical graft failures (P = 0.004 by Fisher's exact test). The cumulative 1 year graft patency was lower in the group with grade 3-5 calcification (33 vs 81%, P = 0.09). The two groups were similar in age, gender, race, diabetes, duration of dialysis, serum calcium, serum phosphorus and serum parathyroid hormone.

Conclusion. There is a strong association between pelvic artery calcifications and technical failure of thigh grafts. The presence of moderate to severe vascular calcification is predictive of poor cumulative 1 year graft patency.

Keywords: dialysis shunts; graft; Doppler ultrasound; haemodialysis; vascular calcification.
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