EFFECTIVENESS OF A MULTIDISCIPLINARY ENDOVASCULAR TEAM ON DIALYSIS ACCESS INTERVENTION AND PATENCY OUTCOMES: THE IN OUT STUDY

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Abstract Title *

EFFECTIVENESS OF A MULTIDISCIPLINARY ENDOVASCULAR TEAM ON DIALYSIS ACCESS INTERVENTION AND PATENCY OUTCOMES: THE IN OUT STUDY

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Co-author 1

Soo Ying YEW syyew@ummc.edu.my University Malaya Medical Centre, Department of Medicine Kuala Lumpur Malaysia *

Co-author 2

Kin Wong CHAN kwchan@ummc.edu.my University of Malaya Department of Biomedical Imaging Kuala Lumpur Malaysia -

Co-author 3

Yi-De NG ng.yide@ummc.edu.my University of Malaya Department of Biomedical Imaging Kuala Lumpur Malaysia -

Co-author 4

Eric Chung eric.chung@ummc.edu.my University of Malaya Department of Biomedical Imaging Kuala Lumpur Malaysia -

Co-author 5

Wei Lin Ng wei.lin@ummc.edu.my University of Malaya Department of Biomedical Imaging Kuala Lumpur Malaysia -

Co-author 6

Daoyao Ling daoyao@ummc.edu.my University of Malaya Department of Surgery Kuala Lumpur Malaysia -

Co-author 7

Muhammad Syafiq IDRIS syafiq.idris@ummc.edu.my University of Malaya Department of Surgery Kuala Lumpur Malaysia -

Co-author 8

Ahmad Rafizi Hariz RAMLI rafizihariz@ummc.edu.my University of Malaya Department of Surgery Kuala Lumpur Malaysia -

Co-author 9

Chye Chung Gan ccgan@ummc.edu.my University of Malaya Department of Medicine Kuala Lumpur Malaysia -

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

The Vascular, Interventional Radiology, and Interventional Nephrology (VIRGIN) team was established in 2023 at University Malaya Medical Centre as a multidisciplinary collaboration aimed at improving care for patients with haemodialysis access dysfunction, including stenosis and thrombosis. Several studies have shown that collaboration reduces the time-to-intervention; its effect on post-intervention access patency remains uncertain. This study evaluates the impact of the VIRGIN team on intervention efficiency and vascular access outcomes.

Methods

A retrospective study was conducted on dialysis access percutaneous endovascular interventions performed between 1/1/2023 and 31/12/2023, analyzing the differences before and after establishing the VIRGIN team. The outcome measures included post-intervention access patency (primary, primary-assisted, secondary), survival analysis, and Cox’s proportional hazards analysis.

Results

In the post-VIRGIN period, there was an increase in cases (Post-VIRGIN, n=83 vs. Pre-VIRGIN, n=47, p=0.042), and yet the time-to-intervention was shorter (Post-VIRGIN, n=14 vs Pre-VIRGIN, n=38 days, p<0.001). This shows increased capability for intervention. In the post-VIRGIN period, there is a trend of a more complicated patient demographic. This is demonstrated in post-VIRGIN cohort patients who exhibited a more extended dialysis vintage(32.9 vs.18.6 months, p=0.012) and a higher percentage of previously failed access (37.3% vs. 10.6%, p=0.001). Inpatient intervention is higher in post-VIRGIN (59.0% vs. 21.3%, p<0.001), reflecting the complexity of the cases that required hospital-based management for optimization and monitoring. Despite these challenges, the 12-month secondary patency remained stable(85.5% vs. 82.9%), whilst primary patency in the post-VIRGIN period improved(76.9% vs. 63.8%). These findings demonstrate that the multidisciplinary VIRGIN team effectively preserved long-term vascular access outcomes even in a more complex patient population.

Conclusion

This study demonstrates the benefits of using a multidisciplinary approach to manage complex dialysis access cases in a real-world setting. Timely interventions and sustained patency rates were made possible by the VIRGIN team's coordinated care model. These results encourage the wider use of similar coordinated care models to improve the outcomes of vascular access across healthcare settings.

This abstract is submitted at the Malaysian Society of Nephrology (MSN) Annual Congress 2025.

Kewords