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

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.

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

Journal of the Association for Vascular Access ◽

10.2309/j.java.2020.001.002 ◽

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.

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Arteriovenous fistula maturation rate is not affected by ipsilateral tunneled dialysis catheter

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.01.084 ◽

2019 ◽

Vol 70 (5) ◽

pp. 1629-1633 ◽

Cited By ~ 3

Author(s):

Jerry J. Kim ◽

Joseph L. Mills ◽

Jonathan Braun ◽

Neal Barshes ◽

Panos Kougias ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dialysis Catheter ◽

Maturation Rate ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation

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Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

The Journal of Vascular Access ◽

10.1177/1129729819897158 ◽

2019 ◽

Vol 21 (5) ◽

pp. 636-645

Author(s):

Dongliang Zhang ◽

Zhoucang Zhang ◽

Li Wan ◽

Jingjing Chang ◽

Rui Zhao

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Resistance Index ◽

Vessel Diameter ◽

Flow Volume ◽

Arteriovenous Fistulas ◽

Blood Flow Volume ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation ◽

Baseline Diameter

Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = −3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = −2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

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

The Journal of Vascular Access ◽

10.1177/1129729819838168 ◽

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.

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