Agreement between physical and ultrasound examination for arteriovenous fistula maturation diagnostics in Thai hemodialysis patients

2020 ◽  
pp. 112972982098317
Author(s):  
Sothida Nantakool ◽  
Mujalin Prasannarong ◽  
Tanop Srisuwan ◽  
Termpong Reanpang ◽  
Poon Apichartpiyakul ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Roc Curve ◽  
Youden Index ◽  
Kappa Statistics ◽  
Vascular Surgeon ◽  
Vein Diameter ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation ◽  
Rule Of Six

Introduction: Physical examination (PE) is used to determine if arteriovenous fistula (AVF) meets criteria for first hemodialysis (HD) cannulation in chronic kidney disease (CKD) with HD patients. Three ultrasound (US) based criteria are adopted to investigate maturation: (i) Rule of Six: blood flow ⩾600 milliliters per minute (mL/min), vein diameter ⩾6 millimeters (mm), vein depth ⩽6 mm); (ii) Rule of Five: blood flow ⩾500 mL/min, vein diameter ⩾5 mm, vein depth ⩽6 mm; and (iii) Rule of Four: blood flow ⩾500 mL/min, vein diameter ⩾4 mm, vein depth ⩽6 mm. In Thai, no study determined optimal US criteria for predicting AVF maturation measured by PE before first cannulation. This study examined the significance of these US criteria on the physical AVF maturation in Thai. Methods: Fifty CKD patients, operated brachiocephalic AVF, were enrolled and examined on the operative day and 6 weeks afterwards. PE was evaluated by an experienced vascular surgeon, and US measurements were obtained by an experienced US technologist. Matching mature number between US criteria and PE was computed using McNemar test. Agreement between US criteria and PE was measured using Kappa. Mature and immature discrimination were evaluated by the Receiver Operator Characteristics (ROC) curve and Youden index. Results: Rule of Six and Rule of Five had higher non-mature matching number than Rule of Four ( p < 0.001 both). Regarding Kappa statistics, Rule of Six and Rule of Five agreed with the PE ( p < 0.01 both). The ROC curve of Rule of Six and Rule of Five were 0.75 and 0.74, respectively ( p <0.01 both). Youden index (maturity and immaturity discriminating performance) of both rules was 0.5 and 0.47, respectively. Conclusion: Rule of Six and Rule of Five agreed with the PE, with the highest performance of the Rule of Six to predict first successful cannulation in Thai.

scholarly journals Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

2019 ◽  
Vol 43 (1) ◽  
pp. 58-61
Author(s):  
Savino Occhionorelli ◽  
Fabio Fabbian ◽  
Yuri Battaglia ◽  
Tommaso Miccoli ◽  
Dario Andreotti ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Flow Rate ◽  
Neointimal Hyperplasia ◽  
Blood Flow Rate ◽  
Absorbable Suture ◽  
Absorbable Sutures ◽  
The Mean ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.

scholarly journals Creating percutaneous radiocephalic arteriovenous fistulas at the wrist

2020 ◽  
pp. 112972982093373
Author(s):  
Alexandros Mallios ◽  
Peter R Nelson ◽  
Gilbert Franco ◽  
William C Jennings
Keyword(s):  
Arteriovenous Fistula ◽  
Late Complications ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulas ◽  
Post Procedure ◽  
Construction Techniques ◽  
Vein Diameter ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: The first arteriovenous fistulas were created at the wrist more than 60 years ago. Basic surgical construction techniques remain unchanged with mobilization and repositioning of the vessels followed by a sutured anastomosis. We used the Ellipsys device to construct percutaneous radiocephalic–arteriovenous fistulas at the wrist and report the results. Methods: Data were reviewed retrospectively for all patients who had a percutaneous radiocephalic–arteriovenous fistula created during a 6-month period. Each individual underwent ultrasound vessel mapping in addition to physical examination. When a radiocephalic–arteriovenous fistula was feasible and a communicating vein ⩾ 2 mm in diameter was noted in the distal forearm along with a radial artery ⩾ 2 mm, a percutaneous radiocephalic–arteriovenous fistula was considered and reviewed with the patient. Results: Four individuals met the criteria to consider a percutaneous radiocephalic–arteriovenous fistula and all elected to have the procedure performed. Ages were 54–85 years. Three were diabetic and one was female. All percutaneous radiocephalic–arteriovenous fistulas were technically successful. Two individuals had not yet started dialysis therapy. Successful and repetitive cannulation for the two individuals with catheters was initiated at 4 and 8 weeks post procedure. The two pre-dialysis patients had physiologic arteriovenous fistula maturation (6 mm vein diameter and >500 mL/min flow) at 4 and 12 weeks. There were no procedural or late complications and none required intervention. Follow-up was 8–23 months (mean 16 months). Conclusion: The success of these percutaneous radiocephalic–arteriovenous fistulas suggests that use of the Ellipsys device will be applicable at the wrist in selected patients where appropriate vessel sizes and configurations are found.

Vein and artery diameter influence on arteriovenous fistula maturation and patency in a Mexican population

2021 ◽  
pp. 112972982110440
Author(s):  
Gustavo Martinez-Mier ◽  
Miguel Angel Cisneros-Tinoco ◽  
Francisco Gerardo Sanchez-Ruiz
Keyword(s):  
Arteriovenous Fistula ◽  
Duplex Ultrasound ◽  
Primary Patency ◽  
Mexican Population ◽  
Single Center ◽  
Vein Diameter ◽  
First Time ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: There is no consensus of the optimal arterial and venous sizes on arteriovenous fistula (AVF) function and patency. The purpose of our study was to determine the influence of vein and artery sizes on maturation and patency in autologous first time AVF in a vascular access clinic of Mexican Social Security. Methods: Approved IRB single-center retrospective study in patients referred for their first AVF from 01/2018/ to 04/2020. Perianastomotic inner vein diameter and single inner artery diameter was recorded by duplex ultrasound. Outcomes were: failure to mature (FTM) and cumulative primary patency survival. Results: Eighty-six AVF’s were created (mean age 45.5 ± 15.1 years; 62.8% male; mean BMI 25.9 ± 4.3 kg/m2). About 86% were brachiocephalic AVF. Eight (8.1%) AVF had FTM. Mean follow-up was 19.7 ± 8.5 months. Two-year patency survival was 81.4%. FTM vein and artery diameters (2.1 ± 0.3 and 2.8 ± 0.7 mm respectively) were smaller than successful AVF’s (3.1 ± 0.9 and 3.5 ± 0.6 mm) ( p < 0.05). ROC curve calculated a 2.15 mm vein diameter cutoff (AUC: 0.86) and a 2.95 mm artery diameter cutoff (AUC: 079) for FTM AVF’s (83% sensitivity, 72% specificity both) ( p < 0.05). AVF’s created with a vein diameter <2.15 mm and <2.95 mm artery diameter had statistically significant lower patency survival than AVF’s with larger vein and artery diameters ( p < 0.05). Conclusion: Vein diameter <2.15 mm and artery diameter <2.95 mm influences AVF maturation and patency in a Mexican population.

Influence of Peripheral Blood Flow Parameters on the Terms of Arteriovenous Fistula Maturation

Flebologiia ◽  
2020 ◽  
Vol 14 (1) ◽  
pp. 25
Author(s):  
A. A. Repin ◽  
P. F. Kravtsov ◽  
S. E. Katorkin ◽  
M. A. Melnikov ◽  
Yu. B. Reshetnikova
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Peripheral Blood ◽  
Peripheral Blood Flow ◽  
Flow Parameters ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

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

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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