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van Vliet LV, Zonnebeld N, Tordoir JH, Huberts W, Bouwman LH, Cuypers PW, Heinen SG, Huisman LC, Lemson S, Mees BME, Schlösser FJ, de Smet AA, Toorop RJ, Delhaas T, Snoeijs MG. Guideline recommendations on minimal blood vessel diameters and arteriovenous fistula outcomes. J Vasc Access 2024; 25:1584-1592. [PMID: 37334775 PMCID: PMC11408960 DOI: 10.1177/11297298231180627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Clinical guidelines provide recommendations on the minimal blood vessel diameters required for arteriovenous fistula creation but the evidence for these recommendations is limited. We compared vascular access outcomes of fistulas created in agreement with the ESVS Clinical Practice Guidelines (i.e. arteries and veins >2 mm for forearm fistulas and >3 mm for upper arm fistulas) with fistulas created outside these recommendations. METHODS The multicenter Shunt Simulation Study cohort contains 211 hemodialysis patients who received a first radiocephalic, brachiocephalic, or brachiobasilic fistula before publication of the ESVS Clinical Practice Guidelines. All patients had preoperative duplex ultrasound measurements according to a standardized protocol. Outcomes included duplex ultrasound findings at 6 weeks after surgery, vascular access function, and intervention rates until 1 year after surgery. RESULTS In 55% of patients, fistulas were created in agreement with the ESVS Clinical Practice Guidelines recommendations on minimal blood vessel diameters. Concordance with the guideline recommendations was more frequent for forearm fistulas than for upper arm fistulas (65% vs 46%, p = 0.01). In the entire cohort, agreement with the guideline recommendations was not associated with an increased proportion of functional vascular accesses (70% vs 66% for fistulas created within and outside guideline recommendations, respectively; p = 0.61) or with decreased access-related intervention rates (1.45 vs 1.68 per patient-year, p = 0.20). In forearm fistulas, however, only 52% of arteriovenous fistulas created outside these recommendations developed into a timely functional vascular access. CONCLUSIONS Whereas upper arm arteriovenous fistulas with preoperative blood vessel diameters <3 mm had similar vascular access function as fistulas created with larger blood vessels, forearm arteriovenous fistulas with preoperative blood vessel diameters <2 mm had poor clinical outcomes. These results support that clinical decision-making should be guided by an individual approach.
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Affiliation(s)
- Letty V van Vliet
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Niek Zonnebeld
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Jan H Tordoir
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | | | - Stefan G Heinen
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Susan Lemson
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Barend ME Mees
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Felix J Schlösser
- Department of Surgery, Laurentius Hospital, Roermond, the Netherlands
| | - André A de Smet
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Raechel J Toorop
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Maarten G Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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Yadav R, Scheltinga MR. Response to: "Guideline recommendations on minimal blood vessel diameters and arteriovenous fistula outcomes". J Vasc Access 2024; 25:1364-1365. [PMID: 38053257 DOI: 10.1177/11297298231201004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Affiliation(s)
- Reshabh Yadav
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Marc Rm Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
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Li D, Hao M, Sheng H, Ge H, Zhu Y. Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas. J Vasc Access 2024; 25:1087-1092. [PMID: 36573705 DOI: 10.1177/11297298221112531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
AIM To assess the value of lumen diameter after percutaneous angioplasty (PTA) to predict functional dialysis use (FDU) of arteriovenous fistulas (AVF). METHODS We performed a retrospective study of all patients who underwent first PTA because of AVF stenosis between March 2019 and March 2021. The outcome was FDU of AVF at 6 months follow up. Independent factors of FDU were identified using multivariate regression analyses. Receiver operating characteristic (ROC) curve was performed to investigate the predictive ability of lumen diameter for FDU. RESULTS A total 68 patients were included into this study and the AVF of 53 cases (77.9%) were good for FDU after 6 months. The AVF age was younger in failure group than that in success group (16.1 ± 9.1 months vs 28.3 ± 20.0 months, p = 0.026). Compared with failure group, the post-PTA minimum luminal diameter (MLD) was bigger in success group (4.5 [4.0-4.5 mm] vs 5.5 mm [4.5-5.5 mm], p < 0.001). Meanwhile, the gain of lumen diameter in success group was also bigger than that in failure group (2.5 mm [2.0-3.0 mm] in failure group vs 3.0 mm [2.75-3.5 mm] in success group, p = 0.012). The residual stenosis was higher in failure group than that in success group (30% [10%-40%] vs 10% [0%-20%], p = 0.003). Logistic regression showed that AVF age and post-PTA MLD were independent predictors of FDU. ROC analysis showed that the gain of lumen diameter, post-PTA MLD and improvement of stenosis were comparable to predict FDU. For post-PTA MLD, the area under ROC curve was 0.804 (95% CI, 0.681-0.927, p < 0.001). The best cutoff is 4.75 mm, with the sensitivity and specificity was 71.7% and 80.0%, respectively. CONCLUSIONS AVF age and post-PTA MLD were independently predictors for FDU of AVF after PTA. To get the best performance, a minimum vein diameter of 4.75 mm should be obtained after angioplasty.
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Affiliation(s)
- Dandan Li
- Department of Vascular Surgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Ming Hao
- Department of Vascular Surgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Haijun Sheng
- Department of Vascular Surgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Hongwei Ge
- Department of Vascular Surgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Yongbin Zhu
- Department of Vascular Surgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
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Hofmann AG, Lama S, Zhang H, Assadian A, Sor M, Hymes J, Kotanko P, Raimann J. Challenges of Predicting Arteriovenous Access Survival Prior to Conversion from Catheter. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00475-1. [PMID: 38857878 DOI: 10.1016/j.ejvs.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The decision to convert from catheter to arteriovenous access is difficult yet very important. The ability to accurately predict fistula survival prior to surgery would significantly improve the decision making process. Many previously investigated demographic and clinical features have been associated with fistula failure. However, it is not conclusively understood how reliable predictions based on these parameters are at an individual level. The aim of this study was to investigate the probability of arteriovenous fistula maturation and survival after conversion using machine learning workflows. METHODS A retrospective cohort study on multicentre data from a large North American dialysis organisation was conducted. The study population comprised 73 031 chronic in centre haemodialysis patients. The dataset included 49 variables including demographic and clinical features. Two distinct feature selection and prediction pipelines were used: LASSO regression and Boruta followed by a random forest classifier. Predictions were facilitated for re-conversion to catheter within one year. Additionally, all cause mortality predictions were conducted to serve as a comparator. RESULTS In total, 38 151 patients (52.2%) had complete data and made up the main cohort. Sensitivity analyses were conducted in 67 421 patients (92.3%) after eliminating variables with a high proportion of missing data points. Selected features diverged between datasets and workflows. A previously failed arteriovenous access appeared to be the most stable predictor for subsequent failure. Prediction of re-conversion based on the demographic and clinical information resulted in an area under the receiver operating characteristic curve (ROCAUC) between 0.541 and 0.571, whereas models predicting all cause mortality performed considerably better (ROCAUC 0.662 - 0.683). CONCLUSION While group level depiction of major adverse outcomes after catheter to arteriovenous fistula or graft conversion is possible using the included variables, patient level predictions are associated with limited performance. Factors during and after fistula creation as well as biomolecular and genetic biomarkers might be more relevant predictors of fistula survival than baseline clinical conditions.
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Affiliation(s)
- Amun G Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria.
| | - Suman Lama
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | | | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Murat Sor
- Azura Vascular Care, Malvern, PA, USA
| | - Jeffrey Hymes
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | - Peter Kotanko
- Renal Research Institute, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jochen Raimann
- Renal Research Institute, New York, NY, USA; Katz School of Science and Health at Yeshiva University, New York, NY, USA
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Richards J, Summers D, Sidders A, Allen E, Thomas H, Hossain MA, Paul S, Slater M, Bartlett M, Lagaac R, Laing E, Hopkins V, Fitzpatrick-Creamer C, Hudson C, Parsons J, Turner S, Tambyraja A, Somalanka S, Hunter J, Dutta S, Hoye N, Lawman S, Salter T, Aslam M, Bagul A, Sivaprakasam R, Smith G, Moinuddin Z, Knight S, Barnett N, Motallebzadeh R, Pettigrew GJ. Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula. Kidney Int Rep 2024; 9:1005-1019. [PMID: 38765580 PMCID: PMC11101727 DOI: 10.1016/j.ekir.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention. Methods Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling. Results Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9-77.3]; elbow, 66.7% [48.9-84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan's findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data. Conclusion Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation.
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Affiliation(s)
- James Richards
- Addenbrooke’s Hospital, Hill Road, Cambridge, UK
- University of Cambridge, Hill Road, Cambridge, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Dominic Summers
- Addenbrooke’s Hospital, Hill Road, Cambridge, UK
- University of Cambridge, Hill Road, Cambridge, UK
| | - Anna Sidders
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Elisa Allen
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Helen Thomas
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | | | - Subhankar Paul
- Addenbrooke’s Hospital, Hill Road, Cambridge, UK
- University of Cambridge, Hill Road, Cambridge, UK
| | | | | | - Regin Lagaac
- Addenbrooke’s Hospital, Hill Road, Cambridge, UK
| | - Emma Laing
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Valerie Hopkins
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | | | - Cara Hudson
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | - Joseph Parsons
- NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK
| | | | | | - Subash Somalanka
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | - James Hunter
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sam Dutta
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Neil Hoye
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Lawman
- Brighton and Sussex University Hospitals NHS Trust, Worthing, West Sussex, UK
| | - Tracey Salter
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
- Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
| | | | - Atul Bagul
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - George Smith
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Zia Moinuddin
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Knight
- Oxford University Hospitals NHS Foundation Trust, Headington Oxford, UK
| | | | | | - Gavin J. Pettigrew
- Addenbrooke’s Hospital, Hill Road, Cambridge, UK
- University of Cambridge, Hill Road, Cambridge, UK
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Feng R, Wang S, Yu J, Zheng X, Chen W, Wang X, Chang G. The feasibility and efficiency for constructing arteriovenous fistula with <2 mm vein-a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1226136. [PMID: 37808887 PMCID: PMC10552868 DOI: 10.3389/fcvm.2023.1226136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Autogenous arteriovenous fistula (AVF) is an efficient hemodialysis access for patients with end-stage kidney disease (ESKD). The specific threshold of vein diameter still not reached a consensus. Method We conducted a comprehensive search in PubMed, Embase, and Web of Science databases for articles which comparing the treatment outcomes of AVF with 2 mm as vein diameter threshold. Fixed and random effect model were used for synthesis of results. Subgroup analysis was designed to assess the risk of bias. Result Eight high-quality articles were included finally. Among a total of 1,075 patients (675 males and 400 females), 227 and 809 patients possessed <2 mm and ≥2 mm vein respectively. Apart from gender and coronary artery disease (P < 0.05), there was no significant difference in age, diabetes, hypertension or radial artery between maturation and non-maturation groups. The functional maturation rate was lower in patients with <2 mm vein according to fixed effect model [OR = 0.19, 95% CI (0.12, 0.30), P < 0.01]. There was no significant difference in primary [OR = 0.63, 95% CI (0.12, 3.25), P = 0.58] or cumulative patency rates [OR = 0.40, 95% CI (0.13, 1.19), P = 0.10]. Conclusion Vein diameter less than 2 mm has a negative impact on the functional maturation rate of AVF, while it does not affect the primary and cumulative patency rates (12 months).
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianwen Yu
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xunhua Zheng
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Etkin Y, Woo K, Guidry L. Options for Dialysis and Vascular Access Creation. Surg Clin North Am 2023; 103:673-684. [PMID: 37455031 DOI: 10.1016/j.suc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
End-stage kidney disease (ESKD) affects nearly 800,000 patients in the United States. The choice of peritoneal dialysis (PD) versus hemodialysis (HD) should be patient centric. An ESKD Life-Plan is crucial with the goal of creating the right access, for the right patient, at the right time, for the right reason. Complex access should be considered when straightforward access options have been exhausted. Evolving techniques such as percutaneous access for HD and PD should be further investigated. Shared decision-making and palliative care is an essential part of the care of patients with CKD and ESKD..
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Affiliation(s)
- Yana Etkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza Suite 526, Los Angeles, CA 90095, USA.
| | - London Guidry
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health and Science Center, New Orleans, LA, USA
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Satam K, Setia O, Moore MS, Schneider E, Chaar CIO, Dardik A. Arterial Diameter and Percentage of Monocytes are Sex-Dependent Predictors of Early Arteriovenous Fistula Maturation. Ann Vasc Surg 2023; 93:128-136. [PMID: 36812979 PMCID: PMC10277224 DOI: 10.1016/j.avsg.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Arteriovenous fistulae mature less frequently in women than in men, leading to inferior patency and decreased fistula utilization in women. We hypothesized that both anatomic and physiologic sex differences explain reduced maturation. METHODS The electronic medical records of patients who had a primary arteriovenous fistula created from 2016 to 2021 at a single center were reviewed; sample size was determined using a power calculation. Postoperative ultrasound and laboratory tests were obtained at least 4 weeks after fistula creation. Primary unassisted fistula maturation was determined up to 4 years postprocedure. RESULTS A total of 28 women and 28 men with a brachial-cephalic fistula were analyzed. The inflow brachial artery diameter was smaller in women than in men, both preoperatively (4.2 ± 0.9 vs. 4.9 ± 1.0 mm, P = 0.008) and postoperatively (4.8 ± 0.8 vs. 5.3 ± 0.9 mm, P = 0.039). Despite similar preoperative brachial artery peak systolic velocity, women had significantly lower postoperative arterial velocity (P = 0.027). Fistula flow was reduced in women, particularly in the midhumerus (747.0 ± 570.4 vs. 1,117.1 ± 471.3 cc/min, P = 0.003). Percentages of neutrophils and lymphocytes were similar among women and men 6 weeks after fistula creation. However, women had reduced monocytes (8.5 ± 2.0 vs. 10.0 ± 2.6%, P = 0.0168). Among 28 men, 24 of 28 (85.7%) achieved unassisted maturation, whereas only 15 of 28 (53.6%) women had fistulae that matured without intervention. Secondary analysis using logistic regression suggested that postoperative arterial diameter was associated with maturation in men, while postoperative monocyte percentage was associated with maturation in women. CONCLUSIONS Sex differences during arteriovenous fistula maturation are present in arterial diameter and velocity, suggesting that both anatomic and physiologic differences in arterial inflow contribute to sex differences in fistula maturation. In men, postoperative arterial diameter is correlated with maturation, whereas in women, the significantly lower proportion of circulating monocytes suggests a role for the immune response in fistula maturation.
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Affiliation(s)
- Keyuree Satam
- Yale School of Medicine, New Haven, CT; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Ocean Setia
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Miranda S Moore
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Eric Schneider
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alan Dardik
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Surgery, VA Connecticut Healthcare Systems, West Haven, CT.
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Barbosa WM, Franco RP, Rodrigues AT. Arteriovenous fistulas maturation: predictors of maturation and use of ultrasound. J Bras Nefrol 2023; 45:272-273. [PMID: 37791793 PMCID: PMC10697155 DOI: 10.1590/2175-8239-jbn-2023-e011en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 10/05/2023] Open
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10
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Feng R, Wang S, Chang G, Zhang WW, Liu Q, Wang X, Chen W, Wang S. The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study. Front Cardiovasc Med 2023; 10:1070084. [PMID: 36776248 PMCID: PMC9909423 DOI: 10.3389/fcvm.2023.1070084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Autogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small-caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation. Design This is a single-center retrospective study. Method Patients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied the eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on the receiver operating curve (ROC) and the Youden index. Kaplan-Meier analysis was utilized in further patency rate comparisons. Result A total of 125 forearm AVFs were created in 121 patients with end-stage renal disease (ESRD). The mean age was 53.88 ± 15.10 years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17 ± 0.54 and 1.71 ± 0.75 mm, respectively. Small-caliber vein is the risk factor for functional maturation failure (OR = 0.256, 95%CI [0.06-0.75], p = 0.033) and additional intervention (OR = 0.306, 95% CI [0.09-0.78], p = 0.031). The optimal cutoff value is 1.35 mm (augmented) when specificity and sensitivity reach 80 and 63.7%, respectively. The AVFs with a vein diameter of more than 1.35 mm (augmented) showed higher patency rates (p < 0.01). Conclusion After comprehensive DUS evaluation, intraoperative hydrodilation, postoperative active exercise and intensive DUS detection, and application of balloon-assisted maturation, if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wayne W. Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Qinghua Liu
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China,*Correspondence: Wei Chen, ✉
| | - Shenming Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Shenming Wang, ✉
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The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure. Life (Basel) 2022; 12:life12091447. [PMID: 36143483 PMCID: PMC9506395 DOI: 10.3390/life12091447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/31/2022] Open
Abstract
Background: An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD). In planning vascular access, it is necessary to check the diameters of the venous and arterial components for satisfactory long-term results. Furthermore, the mechanism underlying the maturation failure and short-term patency in cases of AVFs is not fully known. This study aims to verify the predictive role of inflammatory biomarkers (the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and C-reactive protein (CRP)), Ca-P product, the prognostic nutritional index (PNI), and the diameters of the venous and arterial components in the failure of AVF maturation. Methods: The present study was designed as an observational, analytical, and retrospective cohort study with a longitudinal follow-up, and included all patients with a diagnosis of ESRD that were admitted to the Vascular Surgery Clinic of the Targu Mures Emergency County Hospital, Romania, between January 2019 and December 2021. Results: The maturation of AVF at 6 weeks was clearly lower in cases of patients in the high-NLR (31.88% vs. 91.36%; p < 0.0001), high-PLR (46.94% vs. 85.55%; p < 0.0001), high-SII (44.28% vs. 88.89%; p < 0.0001), high-CRP (46.30% vs. 88.73%; p < 0.0001), high-Ca-P product (40.43% vs. 88.46%; p < 0.0001), and low-PNI (34.78% vs. 91.14%; p < 0.0001) groups, as well as in patients with a lower radial artery (RA) diameter (40% vs. 94.87%; p = 0.0009), cephalic vein (CV) diameter (44.82% vs. 97.14%; p = 0.0001) for a radio-cephalic AVF (RC-AVF), and brachial artery (BA) diameter (30.43% vs. 89.47%; p < 0.0001) in addition to CV diameter (40% vs. 94.59%; p < 0.0001) for a brachio-cephalic AVF (BC-AVF), respectively. There was also a significant increase in early thrombosis and short-time mortality in the same patients. A multivariate analysis showed that a baseline value for the NLR, PLR, SII, CRP, Ca-P product, and PNI was an independent predictor of adverse outcomes for all of the recruited patients. Furthermore, for all patients, a high baseline value for vessel diameter was a protective factor against any negative events during the study period, except for RA diameter in mortality (p = 0.16). Conclusion: Our findings concluded that higher NLR, PLR, SII, CRP, Ca-P product, and PNI values determined preoperatively were strongly predictive of AVF maturation failure, early thrombosis, and short-time mortality. Moreover, a lower baseline value for vessel diameter was strongly predictive of AVF maturation failure and early thrombosis.
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Li YC, Yu SY, Kao TC, Ko PJ, Wei WC, Su TW, Wu YJ, Li YS. The clinical outcome of balloon-assisted maturation procedure between autogenous radiocephalic fistula and brachiocephalic fistula in a single center experience. J Vasc Surg 2022; 76:1060-1065. [PMID: 35697313 DOI: 10.1016/j.jvs.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Balloon-assisted maturation by an endovascular method plays an important role in treating an immature arteriovenous fistula. However, the results between radiocephalic fistula and brachiocephalic fistula were rarely reported. This retrospective study aimed to investigate the effectiveness and outcome of balloon-assisted maturation in different sites of autogenous arteriovenous fistulas. METHODS This single-center retrospective study included patients who underwent balloon-assisted maturation procedures from January 2015 to December 2016. Of 148 patients, 117 and 31 patients had a radiocephalic fistula and a brachiocephalic fistula, respectively. The primary outcome was balloon-assisted maturation success. Data regarding fistula lesions, balloon types and size, frequency of procedures, and maturation time were collected for balloon-assisted maturations. The secondary outcome was the patency of a fistula in the follow-up period. RESULTS No difference was observed in procedure of balloon-assisted maturation frequency between the radiocephalic and brachiocephalic fistula groups. The total success rate was 77.7%, without significant difference between radiocephalic and brachiocephalic fistula groups (81.20% vs. 64.50%; P=0.055). Within the procedures, the culprit lesion of juxta-anastomosis segment (73.5% vs. 25.5%, P<0.001) and arterial inlet (21.2% vs. 7.8%, P=0.04) were more common in the radiocephalic fistula group, whereas the venous outlet was more common in the brachiocephalic fistula group (88.2% vs. 57.7%, P<0.001). Both groups had an equivalent patency rate after the balloon-assisted maturation within the follow-up period (P=0.272). CONCLUSIONS Balloon-assisted maturation was an effective procedure for immature fistulas, without significant difference between the radiocephalic and brachiocephalic fistulas. Through the procedure, the culprit lesions causing non-maturation were found to be different between the two groups. The patency rate between the two groups after surgery seems to be equivalent within the follow-up period.
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Affiliation(s)
- Ying-Ching Li
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Chi Kao
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Cheng Wei
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Wei Su
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jen Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Nursing, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Sheng Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
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McCullough JWS, Coveney PV. High fidelity blood flow in a patient-specific arteriovenous fistula. Sci Rep 2021; 11:22301. [PMID: 34785678 PMCID: PMC8595446 DOI: 10.1038/s41598-021-01435-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
An arteriovenous fistula, created by artificially connecting segments of a patient’s vasculature, is the preferred way to gain access to the bloodstream for kidney dialysis. The increasing power and availability of supercomputing infrastructure means that it is becoming more realistic to use simulations to help identify the best type and location of a fistula for a specific patient. We describe a 3D fistula model that uses the lattice Boltzmann method to simultaneously resolve blood flow in patient-specific arteries and veins. The simulations conducted here, comprising vasculatures of the whole forearm, demonstrate qualified validation against clinical data. Ongoing research to further encompass complex biophysics on realistic time scales will permit the use of human-scale physiological models for basic and clinical medicine.
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Affiliation(s)
- J W S McCullough
- Centre for Computational Science, Department of Chemistry, University College London, London, UK
| | - P V Coveney
- Centre for Computational Science, Department of Chemistry, University College London, London, UK. .,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands.
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Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis. Int Urol Nephrol 2021; 54:185-192. [PMID: 34095992 PMCID: PMC8732889 DOI: 10.1007/s11255-021-02908-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
Purpose Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20–60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis. Methods Retrospective study of patients with AVF creation from January 2017 to December 2018. Outcomes studied were immediate (< 72 h), primary (3 months) AVF failure, six-month/one-year patency, analyzed for predictive clinical, vascular factors as assessed using Pre-operative Doppler Ultrasound(DUS). Results Of 530 AVFs in 460 patients, DUS was done in 426/530 (80.4%), 349/460 (75.8%) were males, mean age was 53.10 ± 14.54 (18–91), 215/460(46.7%) had Diabetes mellitus(DM), 423/460(92%) hypertension. AVFs were radiocephalic in 79/530 (14.9%), brachiocephalic 418/530 (78.9%), brachiobasilic 33/530 (6.2%). AVF Immediate/Primary failure was seen in 64/530 (12.1%), 90/352 (25.6%); Patency at six months/one year in 253/352(71.8%),191/305 (62.6%), respectively. Older age had less immediate failures (AOR 0.97, CI 0.95–0.99, p 0.03). Feeding arterial diameter predicted immediate and primary failure on univariate analysis [OR 0.64 (95% CI 0.49–0.83), 0.62 (95% CI 0.47–0.89), respectively], but not multivariate. Artery diameter of > 4.0 mm had less failures [immediate (p 0.01), primary (p 0.02)], < 2.0 mm had specificity 95.9% and 95.4% for immediate, primary failure respectively. Conclusion AVF failure is 12.1%, immediately; 25.6% three months after construction, Patency at 6 months is 71.8%, one year 62.6%. Immediate failures decrease with age. Artery diameters > 4.0 mm had less, < 2.0 mm had more failures.
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15
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Gjorgjievski N. Answer to the reader: Male gender has better chance for successful maturation of arteriovenous fistula for hemodialysis than female gender. Ther Apher Dial 2021; 25:351-352. [PMID: 33847073 DOI: 10.1111/1744-9987.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nikola Gjorgjievski
- University "St. Cyril and Methodius", University Hospital of Nephrology, Mother Teresa, Skopje, Macedonia, 1000, Macedonia
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Yadav R, Gerrickens MWM, Teijink JAW, Scheltinga MRM. Abnormal preoperative digital brachial index is associated with lower 2-year arteriovenous fistula access patency. J Vasc Surg 2021; 74:237-245. [PMID: 33359237 DOI: 10.1016/j.jvs.2020.12.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the present study was to assess whether a single measurement of the digital brachial index (DBI; systolic finger pressure/systemic pressure ratio), reflecting the arm's circulation, was associated with access patency in patients with severe chronic kidney disease scheduled for arteriovenous fistula (AVF) creation. METHODS A bilateral DBI was obtained using digital plethysmography just before construction of the patient's first AVF from January 2009 to December 2017 at one center. A DBI of 80% to 99% was considered normal, and a DBI of <80% (low) or DBI of ≥100% (high) were considered abnormal. DBI values ipsilateral to the AVF were used for analysis. The primary and secondary access patency rates were calculated using reported standards and compared using standard statistical techniques. RESULTS Data sets of 163 patients were obtained (69 women; age, 71 ± 12 years). The median follow-up was 40 weeks (range, 0-104 weeks; follow-up index, 99% ± 1%). Patients with abnormal preoperative DBI values had lower 2-year primary patency rates (low DBI, 25% ± 11%; high DBI, 28% ± 6%; normal DBI, 49% ± 8%; P = .018). After correction for age, sex, hypertension, diabetes mellitus, cardiovascular disease, smoking status, and a history of ipsilateral central venous catheter use, an adjusted model demonstrated that abnormal DBI values conferred an increased risk of primary patency failure (low DBI [<80%]: hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.13-4.48; high DBI [≥100%]: HR, 1.74; 95% CI, 1.06-2.85; P < .030 for both). Patients with a low preoperative DBI had also had diminished secondary patency (HR, 2.86; 95% CI, 1.08-7.59; P = .035). In contrast, the diameters of the outflow veins did not determine access patency. CONCLUSIONS Patients with abnormal DBI values before AVF construction for hemodialysis had lower 2-year access patency rates compared with patients with a normal DBI. Plethysmographic finger measurements might have a role in the preoperative counseling of patients with severe chronic kidney disease requiring an AVF.
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Affiliation(s)
- Reshabh Yadav
- Department of Surgery, Máxima Medical Center, Veldhoven.
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Vyahalkar S, Chaudhari A, Binnani P, Kulkarni A, Nagarik A, Jawade K, Chandrashekhar S. Comparative study of the effects of two suturing techniques of End-to-side arteriovenous anastomosis on early outcomes of radio-cephalic fistulas. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_58_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhuwania S, Goel R, Bansal R, Saxena S. Prospective evaluation of radiocephalic arteriovenous fistula to determine the causes for non maturity with clinical and ultrasonography-doppler. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gjorgjievski N, Dzekova-Vidimliski P, Trajcheska L, Stojanoska A, Selim G, Rambabova-Bushljetik I, Nikolov I, Gjorgievska J, Janevski Z, Muharremi S, Dejanov P, Spasovski G, Sikole A, Ivanovski N. Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis. Ther Apher Dial 2020; 25:273-281. [PMID: 32749076 DOI: 10.1111/1744-9987.13570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P = 0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation.
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Affiliation(s)
- Nikola Gjorgjievski
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | | | - Lada Trajcheska
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Ana Stojanoska
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Gjulshen Selim
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | | | - Igor Nikolov
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Juija Gjorgievska
- University Hospital for Pediatric Disease, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Zoran Janevski
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | | | - Petar Dejanov
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Goce Spasovski
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
| | - Aleksandar Sikole
- University Hospital of Nephrology, University SS "Cyril and Methodius", Skopje, Macedonia
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Krampf J, Agarwal R, Shenoy S. Contribution of inflow artery to observed flow in a vascular access: A computational fluid dynamic modeling study of an arteriovenous fistula circuit. J Vasc Access 2020; 22:417-423. [DOI: 10.1177/1129729820944069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: The volume of blood flowing through the vascular access is an important parameter necessary to provide adequate dialysis for a functional arteriovenous fistula. Higher blood flows are seen in arteriovenous access that receive inflow from larger arteries such as brachial or axillary compared to those based on medium-caliber radial or ulnar arteries. We hypothesized that an anatomic difference in the length and the diameter of the artery is an important determinant of the flow volume in arteriovenous fistula created at different anatomic locations. Methods: Using computational fluid dynamics, we evaluated the contribution of the length and diameter of inflow artery on simulations performed with geometric models constructed to represent arteriovenous fistula circuits. Lengths and diameters of the inflow artery were altered to mimic arteriovenous fistula created at various locations of the upper extremity with standard and variant anatomy. Results: Models of arteriovenous fistula created with variable lengths and diameters of the inflow artery suggest that the length of the vessel has an inverse linear relationship and the diameter has a direct linear relationship to flow volume. Conclusion: Computational fluid dynamic modeling of arteriovenous fistula can be used to understand the physiologic basis of clinical observations of function. Evaluation of the effect of inflow artery length and diameter helps explain the higher flows seen in arteriovenous fistula created using large caliber arteries for inflow. Computational fluid dynamic modeling helps operators understand the contributions of inflow artery in access function and can guide anastomotic site selection.
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Sharp S, Gascue L, Goldman D, Lawrence PF, Romley J, Woo K. Higher Surgeon Procedure Volume is Associated with Improved Hemodialysis Vascular Access Outcomes. Am Surg 2020. [DOI: 10.1177/000313481908501001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to examine the association between surgeon characteristics, procedural volume, and short-term outcomes of hemodialysis vascular access. A retrospective cohort study was performed using Medicare Part A and B data from 2007 through 2014 merged with American Medical Association Physician Masterfile surgeon data. A total of 29,034 procedures met the inclusion criteria: 22,541 (78%) arteriovenous fistula (AVF) and 6,493 (22%) arteriovenous graft (AVG). Of these, 13,110 (45.2%) were performed by vascular surgeons, 9,398 (32.3%) by general surgeons, 2,313 (8%) by thoracic surgeons, 1,517 (5.2%) by other specialties, and 2,696 (9.3%) were unknown. Every 10-year increase in years in practice was associated with a 6.9 per cent decrease in the odds of creating AVF versus AV G ( P = 0.02). Surgeon characteristics were not associated with the likelihood of vascular access failure. Every 10-procedure increase in cumulative procedure volume was associated with a 5 per cent decrease in the odds of vascular access failure ( P = 0.007). There was no association of provider characteristics or procedure volume with survival free of repeat AVF/AVG or TC placement at 12 months. A significant portion of the variability in likelihood of creating AVF versus AVG is attributable to the provider-level variation. Increase in procedure volume is associated with decreased odds of vascular access failure.
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Affiliation(s)
- Sydney Sharp
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Laura Gascue
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
| | - Dana Goldman
- School of Pharmacy, University of Southern California, Los Angeles, California; and
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | - Peter F. Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - John Romley
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
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22
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Linares-Palomino JP. Still lack evidence to predict maturation of autologous arteriovenous fistula for hemodialysis. Eur J Vasc Endovasc Surg 2018; 56:582. [PMID: 30139573 DOI: 10.1016/j.ejvs.2018.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jose P Linares-Palomino
- University Hospital Virgen de las Nieves, Vascular Surgery Unit, Academic Department of Surgery, Avda. Fuerzas Armadas n°2, 18014 Granada, Spain.
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