Baseline characteristics of arm vessels by preoperative duplex ultrasonography in Korean patients for hemodialysis vascular access

2019 ◽  
Vol 20 (6) ◽  
pp. 646-651
Author(s):  
Minji Cho ◽  
Jung Sun Kim ◽  
Sungsin Cho ◽  
Won Pyo Cho ◽  
Chanjoong Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Multivariate Logistic Regression Analysis ◽  
Duplex Ultrasonography ◽  
Multivariate Logistic Regression ◽  
Baseline Characteristics ◽  
End Stage ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: Preoperative mapping with duplex ultrasonography is crucial for successful vascular access creation for hemodialysis. The aims of this study are to assess the baseline characteristics of arm vessels by preoperative duplex ultrasonography in Korean patients, to find out a preoperative duplex ultrasonography parameter precluding distal arteriovenous fistula creation, to assess the maturation failure rate of arteriovenous fistulas, and to identify associated risk factors. Methods: Preoperative duplex ultrasonography mapping for vascular access creation was done in all patients with end-stage renal diseases during the year 2015. The baseline data of duplex ultrasonography were retrospectively analyzed with follow-up clinical data. Results: A total of 299 end-stage renal disease patients (mean age = 62 years, 62% male) were included. On preoperative duplex ultrasonography, mean diameters of radial artery and cephalic vein at wrist were 2.03 and 2.40 mm in the non-dominant arm and 2.10 and 2.26 mm in the dominant arm, respectively. The most common reason for precluding radial-cephalic arteriovenous fistula at wrist was small-sized cephalic vein. Multivariate logistic regression analysis revealed that the risk factors for inadequate vessels were warfarin treatment, old age (⩾75 years), and peripheral arterial occlusive disease. The rate of arteriovenous fistula maturation failure was 21% and vein diameter <2.5 mm was the only risk factor for arteriovenous fistula maturation failure by multivariate logistic regression analysis. Conclusion: Preoperative duplex ultrasonography evaluation is important to find out inadequate vessels for native arteriovenous fistula and to determine the location of vascular access.

scholarly journals Vascular Access Calcification and Arteriovenous Fistula Maturation

2014 ◽  
Vol 7 (1) ◽  
pp. 22-25
Author(s):  
Timmy Lee
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Calcification ◽  
Vascular Access ◽  
Hemodialysis Vascular Access ◽  
Pathophysiological Role ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

The vascular access serves as the “lifeline” for the hemodialysis patient, but in recent years has become the “Achilles Heel” of the hemodialysis procedure. The vascular health of the vessels used to create arteriovenous accesses is paramount to vascular access maturation and successful outcomes. Vascular calcification is widely present in the vessels of chronic kidney disease (CKD) and end stage renal disease (ESRD) patients, and may also potentially impact the vascular access remodeling process. Few studies have been published to date evaluating vascular calcification as it relates to vascular access outcomes. However, an improved understanding of how vascular calcification plays a pathophysiological role in hemodialysis vascular access dysfunction may improve therapies to treat arteriovenous fistula (AVF) non-maturation and the health of the vessels prior to vascular access creation.

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

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.

Patient selection, education, and cannulation of percutaneous arteriovenous fistulae: An ASDIN White Paper

2019 ◽  
Vol 21 (6) ◽  
pp. 810-817 ◽  
Author(s):  
Haimanot Wasse ◽  
Alejandro C Alvarez ◽  
Debbie Brouwer-Maier ◽  
Jeffrey E Hull ◽  
Saravanan Balamuthusamy ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Wait Time ◽  
White Paper ◽  
Dialysis Unit ◽  
Patient Morbidity ◽  
American Society ◽  
End Stage ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation ◽  
Endovascular Devices

End-stage kidney disease patients who are candidates for surgical arteriovenous fistula creation commonly experience obstacles to a functional surgical arteriovenous fistula, including protracted wait time for creation, poor maturation, and surgical arteriovenous fistula dysfunction that can result in significant patient morbidity. The recent approval of two endovascular devices designed to create a percutaneous arteriovenous fistula enables arteriovenous fistula creation to be placed in the hands of interventionalists, thereby increasing the number of arteriovenous fistula providers, reducing wait times, and allowing the patient to avoid surgery. Moreover, current studies demonstrate that patients with percutaneous arteriovenous fistula experience improved time to arteriovenous fistula maturation. Yet, in order to realize the potential advantages of percutaneous arteriovenous fistula creation within our hemodialysis patient population, it is critical to select appropriate patients, ensure adequate patient and dialysis unit education, and provide sufficient instruction in percutaneous arteriovenous fistula cannulation and monitoring. In this White Paper by the American Society of Diagnostic and Interventional Nephrology, experts in interventional nephrology, surgery, and interventional radiology convened and provide recommendations on the aforementioned elements that are fundamental to a functional percutaneous arteriovenous fistula.

scholarly journals Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease

2018 ◽  
Vol 37 (3) ◽  
pp. 277-286 ◽  
Author(s):  
Muhammad A. Siddiqui ◽  
Suhel Ashraff ◽  
Derek Santos ◽  
Robert Rush ◽  
Thomas Carline ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Predictive Parameters ◽  
Stage Renal Disease ◽  
End Stage ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

The Predictive Factors of Arteriovenous Fistula Maturation in Patients with End-Stage Renal Disease

2020 ◽  
Vol 25 (1) ◽  
pp. 28-34
Author(s):  
Supomo Supomo ◽  
Satya Septia Wahyunigrum ◽  
Aditya Agam Nugraha
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Predictive Factors ◽  
End Stage Renal Disease ◽  
Arterial Diameter ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Highlights Arterial diameter above 2 mm had an almost 5 times better AVF maturation outcome. Average age of ESRD patients who underwent the AVF procedure was above 50 years. Percentage of AVF maturation was higher in men. Hypertension was the most common comorbid factor in ESRD patients.

scholarly journals Correlation Between Preoperative Vein Distensibility With Radiocephalic Arteriovenous Fistula Maturation in Patients With End Stage Renal Disease

2021 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Putie Hapsari ◽  
Teguh Marfen Djajakusumah ◽  
Zacky Fauzie ◽  
Muhammad Faiz Ulurrosyad
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Statistical Significance ◽  
Test Model ◽  
Venous Distensibility ◽  
Stage Renal Disease ◽  
End Stage ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Introduction: Patients with end stage renal disease require hemodialysis. Radiocephalic arteriovenous fistula is the main choice of vascular access in patients who undergo hemodialysis procedure. Physiological vein distensibility is an important aspect in forming a mature arteriovenous fistula. This study aims to analyze the correlation between preoperative distensibility and arteriovenous fistula maturation. Method: Data are collected from end stage renal disease patients in Hasan Sadikin Hospital and RA Habibie Hospitals that will go through radiocephalic arteriovenous fistula procedure during the period of October 2018 to February 2019. Vein distension procedure is performed before the operation and maturation is evaluated four to six weeks after the operation. The comparison of preoperative venous distensibility in two different groups of arteriovenous fistula maturation category is analyzed using chi square test model. Result: This study found that preoperative venous distensibility value affects arteriovenous fistula maturation with a statistical significance (p-value = 0.007), yielding a contingency coefficient of 0.553, and a very strong relation value of 0.782. Conclusion: Preoperative vein distensibility of more than 30% is predictive of successful arteriovenous maturation.

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

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.

Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation

2017 ◽  
Vol 18 (3) ◽  
pp. 185-191 ◽  
Author(s):  
Juan C. Duque ◽  
Laisel Martinez ◽  
Marwan Tabbara ◽  
Denise Dvorquez ◽  
Sushil K. Mehandru ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Arteriovenous Fistulas ◽  
Ckd Stage ◽  
Artery Disease ◽  
The University ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Introduction Multiple factors and comorbidities have been implicated in the ability of arteriovenous fistulas (AVF) to mature, including vessel anatomy, advanced age, and the presence of coronary artery disease or peripheral vascular disease. However, little is known about the role of uremia on AVF primary failure. In this study, we attempt to evaluate the effect of uremia on AVF maturation by comparing AVF outcomes between pre-dialysis chronic kidney disease (CKD) stage five patients and those who had their AVF created after hemodialysis (HD) initiation. Methods We included 612 patients who underwent AVF creation between 2003 and 2015 at the University of Miami Hospital and Jackson Memorial Hospital. Effects of uremia on primary failure were evaluated using univariate statistical comparisons and multivariate logistic regression analyses. Results Primary failure occurred in 28.1% and 26.3% of patients with an AVF created prior to or after HD initiation, respectively (p = 0.73). The time of HD initiation was not associated with AVF maturation in multivariate logistic regression analysis (p = 0.57). In addition, pre-operative blood urea nitrogen (p = 0.78), estimated glomerular filtration rate (p = 0.66), and serum creatinine levels (p = 0.14) were not associated with AVF primary failure in pre-dialysis patients. Conclusions Our results show that clearance of uremia with regular HD treatments prior to AVF creation does not improve the frequency of vascular access maturation.

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