THE PREVAIL PROGRAM: A MULTIDISCIPLINARY PREEMPTIVE ANGIOPLASTY STRATEGY TO PROLONG HEMODIALYSIS VASCULAR ACCESS LONGEVITY AT JOHNS HOPKINS ARAMCO HEALTHCARE

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THE PREVAIL PROGRAM: A MULTIDISCIPLINARY PREEMPTIVE ANGIOPLASTY STRATEGY TO PROLONG HEMODIALYSIS VASCULAR ACCESS LONGEVITY AT JOHNS HOPKINS ARAMCO HEALTHCARE

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Co-author 1

Mohammad Elraggal mohammad.elraggal@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia *

Co-author 2

Ali AlShaqaq Ali.Alshaqaq@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia -

Co-author 3

Mahmoud Ahmed Mahmoud.Ahmed2@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia -

Co-author 4

Bridget Britton bridget.britton@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia -

Co-author 5

Abdulrazack Amir Abdulrazack.amir@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia -

Co-author 6

Ahmed Khunaizi Ahmed.khunaizi@jhah.com Johns Hopkins Aramco Healthcare Nephrology Khobar Saudi Arabia -

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

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Co-author 15

Introduction

Vascular access dysfunction remains a leading cause of morbidity in patients on maintenance hemodialysis. In response, the PREVAIL program (Preemptive Angioplasty to Improve Lifespan of Vascular Access in Hemodialysis) was established at Johns Hopkins Aramco Healthcare (JHAH) to proactively preserve arteriovenous grafts (AVGs) and fistulas (AVFs) through scheduled angioplasty and multidisciplinary care coordination.

Methods

This retrospective observational study included all patients enrolled in the PREVAIL program between 2014 and 2024. Patients are enrolled in the program once their access required any endovascular intervention. Data on access type, intervention frequency, and outcomes were collected. The primary outcome was 1-year access patency. Secondary outcomes included 2-, 3-, and 5-year patency rates. Interventions were planned at regular 6–8 week intervals and reviewed in a multidisciplinary team (MDT) meeting comprising nephrologists, interventional radiologists, vascular surgeons, cardiologists, and a vascular access nurse coordinator.

Results

A total of 52 patients (mean age 62 ± 14 years; 50% female) with 70 vascular accesses (46 AVGs, 24 AVFs) were followed. The mean access age was 4.1 years. Mean (±SD) duration to first intervention was 0.76 (±0.97) years. Across the cohort, 765 endovascular interventions were performed (mean: 3.4 interventions/access/year). The PREVAIL program achieved the following patency outcomes:

1-year patency: 81.4%

2-year patency: 64.3%

3-year patency: 48.5%

5-year patency: 24.3%

Conclusion

The PREVAIL program demonstrates that a structured, preemptive angioplasty protocol embedded in a multidisciplinary framework can substantially improve vascular access longevity in hemodialysis patients. The observed high patency rates and reduced access loss support broader adoption of similar proactive care models to optimize dialysis outcomes and resource utilization.

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