Independent association of arteriovenous ratio index on the primary functional maturation of autologous radiocephalic arteriovenous fistula

Objective The arteriovenous fistula (AVF) is the preferred method of long-term haemodialysis. However, it has been shown to have a substantial rate of maturation failure. The formation of an AVF creates haemodynamic changes to blood flow in the arm with diversion of blood away from the distal circulation into the low pressure venous system, in turn, leading to thermal changes distally. In this study, we aimed to assess the novel use of infrared thermal imaging as a predictor of arteriovenous maturation. Methods A prospective cohort study was conducted on 100 consecutive patients who had AVF formation from December 2015 to June 2016. Infrared thermal imaging was undertaken pre- and post-operatively on the day of surgery to assess thermal changes to the arms and to assess them as predictors of clinical patency and functional maturation. Results For clinical patency, infrared thermal imaging was found to have a positive predictive value of 88% and a negative predictive value of 86%. For functional maturation, it was found to have a positive predictive value of 84%, a negative predictive value of 95%. In addition, it was shown to have superiority to the commonly used intra-operative predictor of thrill as well as other independent pre-operative patient factors. Conclusions Infrared thermal imaging has been found to be a very useful tool in accurately predicting fistula patency and maturation.

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Peer review report 1 on “S-Shaped versus Conventional Straight Skin Incision: Impact on Primary Functional Maturation, Stenosis and Thrombosis of Autogenous Radiocephalic Arteriovenous Fistula”

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2017.08.023 ◽

2017 ◽

Vol 13 ◽

pp. 269

Keyword(s):

Arteriovenous Fistula ◽

Peer Review ◽

Skin Incision ◽

Functional Maturation

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The independent association of preoperative serum albumin on the functional maturation of radiocephalic arteriovenous fistulae

The Journal of Vascular Access ◽

10.5301/jva.5000646 ◽

2017 ◽

Vol 18 (2) ◽

pp. 148-152 ◽

Cited By ~ 2

Author(s):

Ali Kordzadeh ◽

Evripidis Tokidis ◽

Alan Askari ◽

Mekhola Hoff ◽

Yiannis Panayiotopoulos

Keyword(s):

Null Hypothesis ◽

Causal Link ◽

Multivariate Logistic Regression Model ◽

Arteriovenous Fistulae ◽

Functional Maturation ◽

Preoperative Serum ◽

Chi Squared ◽

Independent Association ◽

Independent Marker ◽

Preoperative Albumin

Purpose The aim of this study is to test the null hypothesis that preoperative albumin along with other preoperative confounders have no impact on the functional maturation of radiocephalic arteriovenous fistulae (RCAVF). Methods A retrospective cohort study of n = 195 individuals undergoing RCAVF formation from July 2013 to December 2015 was conducted. The null hypothesis was assessed through chi squared test. Independent association of each variable was evaluated through univariate and multivariate logistic regression model. Pearson's correlation test was also performed between scale variables to establish their causal link. Results Preoperative hypoalbuminaemic group of individuals demonstrated significant failure of maturation (49.3% vs. 27.2%, p = 0.002). At multivariate analysis, hypoalbuminemia remained an independent marker of fistula failure (OR 0.40, 95% CI 0.21-0.76, p = 0.004) and demonstrated a weak but a positive correlation at the endpoint of maturation (R = 0.223, p = 0.002). Conclusions Preoperative hypoalbuminemia (<35 mg/dL) is independently associated with 40% reduction in the functional maturation of RCAVF. Stratification of this readily available biomarker prior to RCAVF formation may require consideration subjected to further research.

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