The effect of preprocedural serum albumin to fibrinogen ratio on arteriovenous fistula maturation

Introduction Inflammation plays a critical role in neointimal hyperplasia (NH), which leads to arteriovenous fistula (AVF) failure in hemodialysis patients. However, the spatial distribution of macrophages in vivo post AVF creation remains unclear. In this study, we mapped the distribution of macrophages in AVF using intravital fluorescence microscopy (IVFM) and a fluorescence macrophage nanosensor, CLIO-VT680. We hypothesized that the intensity of CLIO-VT680 signals would illuminate the topography of AVF inflammation. Methods AVF was created in C57BL/6J mice (n=5) by end to side anastomosis between the jugular vein and the ipsilateral carotid artery. Mice were injected with CLIO-VT680 (10mg/kg) at day 13 post AVF creation and imaged by IVFM 24 hours later. AVF was resected at week 6, and Von Gieson (VVG) staining was performed. Mean CLIO signal intensity (MSI) was measured every 60μm from the anastomosis. Target to background ratios (TBRs) were calculated as the MSI of AVF divided by the MSI of the control artery. TBR ratio was calculated by the TBRs at different distance away from the anastomosis divided by the TBR at the anastomotic site. Results The survival rate of mice after AVF creation was 100%. The penetration depth of IVFM was 200μm. IVFM detected significantly higher TBRs of CLIO signals near the anastomotic site (p<0.05). There is a linear relationship between TBR ratios and the distance away from the anastomosis (R2=0.99). VVG staining of resected AVF showed the volume of NH decreased as the distance away from the anastomosis increased. Conclusion Macrophages response can be detected via CLIO-VT680 using IVFM. In vivo molecular imaging may be able to predict AVF failure.

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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.

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