Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis

Abstract Purpose Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20–60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis. Methods Retrospective study of patients with AVF creation from January 2017 to December 2018. Outcomes studied were immediate (< 72 h), primary (3 months) AVF failure, six-month/one-year patency, analyzed for predictive clinical, vascular factors as assessed using Pre-operative Doppler Ultrasound(DUS). Results Of 530 AVFs in 460 patients, DUS was done in 426/530 (80.4%), 349/460 (75.8%) were males, mean age was 53.10 ± 14.54 (18–91), 215/460(46.7%) had Diabetes mellitus(DM), 423/460(92%) hypertension. AVFs were radiocephalic in 79/530 (14.9%), brachiocephalic 418/530 (78.9%), brachiobasilic 33/530 (6.2%). AVF Immediate/Primary failure was seen in 64/530 (12.1%), 90/352 (25.6%); Patency at six months/one year in 253/352(71.8%),191/305 (62.6%), respectively. Older age had less immediate failures (AOR 0.97, CI 0.95–0.99, p 0.03). Feeding arterial diameter predicted immediate and primary failure on univariate analysis [OR 0.64 (95% CI 0.49–0.83), 0.62 (95% CI 0.47–0.89), respectively], but not multivariate. Artery diameter of > 4.0 mm had less failures [immediate (p 0.01), primary (p 0.02)], < 2.0 mm had specificity 95.9% and 95.4% for immediate, primary failure respectively. Conclusion AVF failure is 12.1%, immediately; 25.6% three months after construction, Patency at 6 months is 71.8%, one year 62.6%. Immediate failures decrease with age. Artery diameters > 4.0 mm had less, < 2.0 mm had more failures.

Download Full-text

RISK-1: One-year Retrospective Study to Assess Cardiovascular Risk at the Onset of Type 2 Diabetes Mellitus in Slovenia

Metabolism ◽

10.1016/j.metabol.2020.154481 ◽

2021 ◽

Vol 116 ◽

pp. 154481

Author(s):

Iris Marolt ◽

Jana Komel ◽

Elena Kuzmina ◽

Anja Babič ◽

Renata Kopriva ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiovascular Risk ◽

Retrospective Study ◽

One Year

Download Full-text

Patient characteristics predict patency of early-cannulation arteriovenous grafts

Scientific Reports ◽

10.1038/s41598-021-87750-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

David B. Kingsmore ◽

Karen S. Stevenson ◽

S. Richarz ◽

Andrej Isaak ◽

Andrew Jackson ◽

...

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Vascular Access ◽

Demographic Data ◽

Univariate Analysis ◽

Patient Characteristics ◽

Peripheral Vascular ◽

Arteriovenous Grafts ◽

One Year

AbstractThere is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly, strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered.

Download Full-text

Atypical presentation of fistula dysfunction due to brachial arterial embolization mimicking stroke

The Journal of Vascular Access ◽

10.1177/11297298211067686 ◽

2022 ◽

pp. 112972982110676

Author(s):

Rita Vicente ◽

Laura Rodriguez ◽

Joaquim Vallespín ◽

Carolina Rubiella ◽

Jose Ibeas

Keyword(s):

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Vascular Access ◽

Brachial Artery ◽

Arterial Embolization ◽

Limb Ischemia ◽

Artery Occlusion ◽

Bedside Ultrasound ◽

Computed Tomographic ◽

Ultrasound Evaluation

Vascular access thrombosis is an important complication with great impact on access patency and, consequently, on a patient’s quality of life and survival. We report the case of a 73-year-old woman with chronic kidney disease on hemodialysis with a radiocephalic arteriovenous fistula on the right arm that was brought to the emergency department with decreased strength in her right arm, ipsilateral hypoesthesia and facial hemi-hypoesthesia. The patient was given a brain computed tomographic scan that did not confirm suspicion of stroke. On re-examination, the patient had new-onset pain at arteriovenous fistula level, and her right arm was cold and pale. The nephrology department was called for arteriovenous fistula evaluation. On physical examination, her forearm fistula had a decreased thrill and arm elevation exacerbated its paleness. A bedside ultrasound was performed for arteriovenous fistula assessment. Doppler ultrasound revealed: partial thrombosis at brachial bifurcation, a flow of 80–105 mL/min at brachial artery level and a radial artery with a damped waveform. Anastomosis and draining vein were permeable. In this case, the diagnosis of acute embolic brachial artery occlusion was made by a fast bedside ultrasound evaluation. The patient underwent thromboembolectomy with Fogarty technique, recovering fistula thrill, radial and cubital pulses. Thromboembolism of the fistula feeding artery is a rare cause of vascular access thrombosis and it is rarely mentioned in the literature. In this report, failure to recognize the upper limb ischemia would have led to delayed treatment, potentially resulting in the fistula’s complete thrombosis and further limb ischemia. We highlight the importance of a diagnosis method like Doppler ultrasound, which allows for rapid evaluation at the patient’s bedside.

Download Full-text

Preoperative noninvasive artery flow volume and maturation of arteriovenous fistulae: A single surgeon’s experience from 403 cases

The Journal of Vascular Access ◽

10.1177/1129729819881605 ◽

2019 ◽

Vol 21 (4) ◽

pp. 434-439

Author(s):

George Blessios ◽

Alexander Hlepas ◽

Alonso Diaz

Keyword(s):

Risk Factors ◽

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Significant Risk ◽

Flow Volume ◽

Arterial Diameter ◽

Ultrasound Evaluation ◽

Maturation Rate ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation

Background: Preoperative Doppler ultrasound evaluation of arteriovenous fistula inflow artery includes measurements of arterial diameter and flow volume. The purpose of this study was to evaluate the significance of flow volume to arteriovenous fistula maturation rate. Study design: Review of consecutive patients who underwent arteriovenous fistula creation by a single surgeon. Cases with available preoperative arterial diameter and flow volume were analyzed. Primary end point was arteriovenous fistula failure to mature. Information collected included demographics, Doppler ultrasound reports, level of inflow artery, operative reports, and outcomes to the time of arteriovenous fistula maturation or failure. Risk factors were identified by logistic regression analysis. Outcomes were compared by odds ratio. Results: Four hundred and three cases were identified. Arterial diameter and flow volume were both independent significant risk factors affecting arteriovenous fistula maturation rate (p = 0.001). Arterial diameter of <2.5 mm and flow volume of <20 mL/min predicted failure to mature with 95% specificity. Further comparison of cases with optimal arterial diameter but flow volume of <20 mL/min showed increased failure to mature rate compared to the combination of optimal arterial diameter with optimal flow volume (p = 0.01) Conclusion: Preoperative arterial diameter and flow volume values were both significant independent variables affecting arteriovenous fistula maturation rate. However, flow volume of <20 mL/min remained a significant risk factor to failure-to-mature rate, despite optimal arterial diameter.

Download Full-text

Introducing a “no-touch” maneuver to manage challenging anastomoses in arteriovenous fistulae

The Journal of Vascular Access ◽

10.1177/1129729820968396 ◽

2020 ◽

pp. 112972982096839

Author(s):

Efstratios Georgakarakos ◽

Kalliopi-Maria Tasopoulou ◽

George S Georgiadis

Keyword(s):

Surgical Technique ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Surgical Outcome ◽

Dialysis Patients ◽

Synthetic Graft ◽

Arteriovenous Fistulae ◽

Feeding Tubes

Native arteriovenous fistula or interposition of a synthetic graft for vascular access is crucial for dialysis patients. Optimal surgical technique, microsurgery instrumentation and preventive hemostasis are considered beneficial for a successful surgical outcome. We describe a simple and novel maneuver using soft-feeding tubes to facilitate the manipulation of veins and perform successful anastomoses without using microsurgery instrumentation or vascular clamps during operations for vascular access.

Download Full-text

A retrospective study on palmoplantar psoriasis and its associations in a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20190960 ◽

2019 ◽

Vol 5 (2) ◽

pp. 277

Author(s):

Saradha K. Perumal ◽

Sudha R. Gopinath

Keyword(s):

Diabetes Mellitus ◽

Retrospective Study ◽

Plaque Psoriasis ◽

Tertiary Care ◽

Overweight And Obesity ◽

Care Centre ◽

Tertiary Care Centre ◽

Female Ratio ◽

Plaque Type ◽

One Year

Background: Psoriasis is a chronic immune mediated inflammatory condition of the skin. Palmoplantar psoriasis (PPP) is a clinical variant of plaque psoriasis affecting palms and soles extending to the wrist and the margins of the soles and heels. This study was done to find out the prevalence of palmoplantar psoriasis in our setting. The aim of the study was to determine the prevalence, demographic features and other co-morbidities of the palmoplantar plaque psoriasis in a tertiary care centre.Methods: We conducted retrospective study for a period of one year (January 2017 to December 2017) on palmoplantar plaque psoriasis patients attending the dermatology OPD.Results: Among 552 enrolled psoriasis patients, 85 were clinically diagnosed to have palmoplantar psoriasis. The mean age of the patient was 45 years. Most of them belong to 4th, 5th and 6th decade of life. The male to female ratio was 1:2.26. The duration of the disease was more than one year in 73% of patients at the study time. Occupation of the patients included house-wives (50%), manual labourers (36%) and office goers, (13%). Hyperkeratotic plaque type psoriasis with scaling and fissures was the predominant morphological pattern recorded. Dyslipidemia (22%), overweight and obesity (56%), hypothyroidism (6%) and diabetes mellitus (12%) were the observed co-morbidities in this study.Conclusions: The prevalence of palmoplantar psoriasis (0.09%) was low in our study. Palmoplantar psoriasis affected middle aged adults and had a female predominance in this study. Overweight, obesity, dyslipidemia, diabetes mellitus and hypothyroidism were the co-morbid conditions observed in this study. Being a relapsing and chronic condition the disease poses a poor quality of life than plaque type psoriasis.

Download Full-text

Flow volume measured by duplex ultrasound in native arteriovenous fistula for hemodialysis: a case report

Journal of Indonesia Vascular Access ◽

10.51559/jinava.v1i2.14 ◽

2021 ◽

Vol 1 (2) ◽

pp. 28-31

Author(s):

Ronald Winardi Kartika

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Vascular Access ◽

Duplex Ultrasound ◽

Sample Volume ◽

Flow Volume ◽

Pulsed Doppler ◽

Av Fistula ◽

Av Fistulas

Background : Native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. AVF lasts longer than artificial grafts or central venous catheters. In addition, AVF has fewer complications than other vascular accesses. The use of Doppler ultrasound is used to facilitate fistula construction (vascular mapping) including AVF maturation to see if AVF can be used. Doppler ultrasound monitoring for maturation of AV fistulas should be monitored sonographically until the fistula is ready for use, especially when maturation is slow and in patients whose veins cannot easily be assessed by physical examination alone (eg because of obesity). The AVF DUS flow volume measurement may be the only imaging tool that can be used to monitor a fistula even during its maturation. Even so, DUS should always be done before AVF is used for the first time. This examination provides baseline data on vascular access, which can be useful in subsequent tests performed to evaluate functional problems. Case report : A man, 52 years old who has done AV Fitula two weeks ago. Currently patients are using a double lumen catheter (CDL) for routine hemodialysis. One day the patient had his CDL removed. Even though the patient feels thrill in the AV fistula, the nephrorologist still doubts whether the AV fistula is ripe and can be used. For this reason, a Duplex Ultrasound is performed to assess the diameter, velocity flow, PSV and TAMV .By positioning the sample volume in the presumed stenosis site, the Doppler velocity test detects a systolic peak velocity. Conclusion: Color flow Doppler imaging should be used as a tool to screen for areas of high velocity and to aid in the optimal placement of the pulsed Doppler sample volume. The pulsed Doppler sample volume should be set at the smallest size possible to detect discrete changes in blood flow meanwhile doppler ultrasound should be use in monitoring for maturation of AV fistulas

Download Full-text

Hemodynamic impact of VASQ device in vascular access creation

The Journal of Vascular Access ◽

10.1177/1129729820983153 ◽

2020 ◽

pp. 112972982098315

Author(s):

Roberto Palumbo ◽

Sara Dominijanni ◽

Alessia Centi ◽

Gabriele D’Urso ◽

Paola Tatangelo ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Complication Rate ◽

Neointimal Hyperplasia ◽

Arterial Flow ◽

Control Group ◽

Secondary Patency ◽

Arteriovenous Fistulae ◽

The Mean ◽

The Impact

Background: Native arteriovenous fistula is the preferred vascular access in term of functionality, efficiency and complication rate. Nevertheless, research continues to seek strategies to reduce the risk of neointimal hyperplasia and hemodynamic modification. The aim of the study was to evaluate the impact on hemodynamic of the VasQ device in arteriovenous fistulae creation. Methods: The analysis included patients who underwent to fistula creation with or without implantation of the VasQ device between May and September 2019. The hemodynamic parameters were evaluated pre-operatively and at a follow-up of 1, 3, 6 months. The patency and complication rate were evaluated. Results: Fifteen VasQ devices were implanted during 30 arteriovenous fistula surgery. The baseline patients features were similar between groups (VasQ treated/control). At baseline, preoperative arterial flow was similar; radial artery diameter at surgical site was 3.4 ± 0.8 mm in treated and 2.8 ± 0.5 mm in the control group. The mean arterial flow at 1 month was 480 ± 210 mL/min in treated and 561 ± 27 mL/min in the control group. At 3 months the mean arterial flow in treated was 645 ± 143 mL/min versus 824 ± 211 mL/min ( p = 0.02) in the control group; at 6 months the arterial flow was 714 ± 146 mL/min versus 810 ± 194 mL/min ( p = 0.05) in control group. The cardiac output flow at 6 months in the treated group was 4458 ± 928 mL/min versus 5599 ± 1355 mL/min ( p = 0.05) in the control group. At 6 months the primary patency was 73% and 80% and the secondary patency 80% and 86% in treated compared to the control group, respectively. No VASQ device complications were recorded. Conclusion: The analysis of these data suggested that using VasQ device could be protective against the hemodynamic modification that occur during arteriovenous fistulae creation.

Download Full-text

Patient Characteristics Predict Patency of Early-Cannulation Arteriovenous Grafts

10.21203/rs.3.rs-120913/v1 ◽

2020 ◽

Author(s):

David Kingsmore ◽

Karen Stevenson ◽

Sabine Richarz ◽

Andrej Isaak ◽

Andrew Jackson ◽

...

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Vascular Access ◽

Demographic Data ◽

Univariate Analysis ◽

Patient Characteristics ◽

Peripheral Vascular ◽

Arteriovenous Grafts ◽

One Year

Abstract There is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered.

Download Full-text

MO774PREDICTIVE FACTORS FOR PROSTHESIC ARTERIOVENOUS FISTULA OPTION BY DUPLEX DOPPLER ULTRASOUND VASCULAR MAPPING

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab103.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Joana Marques ◽

Tiago Pereira ◽

Rui Barata ◽

Miguel Bigotte Vieira ◽

Fernando Nolasco

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Vascular Access ◽

Distributed Data ◽

Multivariate Logistic Regression ◽

Black Race ◽

Vascular Mapping ◽

Duplex Doppler

Abstract Background and Aims Vascular access (VA) remains the lifeline for hemodialysis (HD) patients. Arteriovenous fistulas (AVF) are recommended over prosthesic arteriovenous fistula (PAF). However, the choice of the type of VA still reflects local practice differences and patient-specific demographic and clinical factors. Duplex Doppler ultrasound (DDU) has been shown to be useful in evaluation of both structural and functional aspects of the peripheral vessels, and is emerging as the preferred method for VA planning. Our aim was to find predictive factors for PAF creation in our population, i.e. when AVF was not feasible. Method We retrospectively analysed a cohort of chronic kidney disease patients who underwent DDU vascular mapping for preoperative planning of HD access at a tertiary referral centre from 2019 to 2020. All the exams were performed by the same DDU operator. Demographic, clinical and DDU characteristics were studied. Continuous variables were recorded as means (±SD) for normally distributed data or as medians (interquartile ranges) for non-normally distributed data. Comparisons were made using t tests or Wilcoxon rank sum tests as appropriate. Categorical variables were evaluated by frequency distribution and recorded as proportions. Comparisons were made using the x2 test. Unadjusted and adjusted multivariate logistic regression models were fitted to identify risk factors to PAF creation due to not being a good candidate for AVF. Results A total of 252 patients were included. The mean age was 65±16 years, 144 (57%) were male, 211 (84%) where white, 40 (16%) were black and 1 (0.4%) was asian. Two hundred and thirty seven (94%) patients were right-handed and 186 (74%) were being evaluated for the first vascular access. The majority had arterial hypertension (HT) (205 (81%)); 98 (39%) had Diabetes Mellitus (DM), 89 (35%) were current or past smoker and 72 (29%) were obese. Most patients were considered appropriate candidates for AVF (207, 82%), whereas 45 (18%) were assigned to PAF. Figure 1 compares the DDU’s arterial indexes of each group. In a multivariate logistic regression model adjusted for age, sex, HT, DM and obesity, black race was found to be a predictor of being a candidate for PAV creation (OR 2.46; CI 95% 1.05-5.71; p-value 0.036). Conclusion Our study revealed that black race is an independent factor for PAV creation even after adjusting for classic risk factors as age, DM or HT. Long known insidious factors, such as poor socioeconomic status or poor access to medical care, have been pointed as justifiers to this disparity. However, facing the PAF-associated risks, we believe that further work must be done to clarify potential involved anatomical factors and potential reversible factors. Those patients have been described throughout the literature as presenting with higher risk of VA failure and severe peripheral arterial disease. In parallel we found that radial and ulnar arteries diameters and radial pulse wave velocity (PWV) in DDU were significantly lower in PAV-submitted patients, suggesting distal arterial compromise and stiffness. Our work has some limitations: neither vein parameters nor VA outcomes were analysed. However, it introduces a relationship between the black race and worse arterial indexes, and their impact on the choice of type of VA, as they seem not to be good candidates for AVF.

Download Full-text