Hybrid arteriovenous grafts for hemodialysis access: A 10-year single-centre experience with off-the-shelf stent-graft configurations

INTRODUCTION: Hybrid arteriovenous grafts (AVGs) incorporating a stented venous outflow were developed to facilitate access creation in patients with unfavorable venous anatomy. Following discontinuation of dedicated hybrid graft devices, off-the-shelf (OTS) stent-graft configurations have been adopted. We report our 10-year institutional experience and evaluate patency outcomes and reintervention burden. METHODS: A retrospective review of consecutive hybrid AVGs created between 2014 and 2024 was performed. Patients were stratified by configuration: dedicated Gore Hybrid Vascular Graft (GHVG) versus OTS graft plus covered stent. Primary, assisted primary, and secondary patency were calculated using Kaplan-Meier analysis. Reinterventions were analyzed descriptively and expressed per patient-year. RESULTS: Forty hybrid AVGs were created (GHVG, 7 (17.5%); OTS, 33 (82.5%)). Median follow-up was 37.3 months. Primary patency was 50.7% at 6 months and 31.0% at 12 months (median 6.4 months). Assisted primary patency was 68.8% at 6 months and 52.3% at 12 months (median 12.1 months). Secondary patency was 89.3% at 12 months and 83.6% at 24 months (median 71.2 months). A total of 172 reinterventions were performed (1.30 per patient-year). The most frequent lesions were venous stent-edge and cannulation-site stenoses. No statistically significant difference in patency was observed between GHVG and OTS configurations. CONCLUSIONS: Hybrid AVG construction provides durable secondary patency despite limited primary patency, with an acceptable reintervention burden. Off-the-shelf configurations demonstrate outcomes comparable to dedicated hybrid devices and represent a practical option for patients with complex venous outflow anatomy.