Intervention for autologous arteriovenous fistula non-maturation is worthwhile and results in an increased number of functional fistulae. The outcome of surgical revision is better than endovascular and might be preferable in certain patient populations.
WHAT THIS PAPER ADDS Arteriovenous fistulae continue to mature over the course of three post-operative months, which is longer than the conventional maturation period of six weeks. In addition, these maturation changes are accelerated in patients that had had previous ipsilateral vascular access, but there is no clear beneficial or detrimental effect thereof.Objective: The aim of the study was to observe the natural haemodynamic changes after arteriovenous fistula (AVF) creation in haemodialysis patients with and without a previous ipsilateral vascular access. Methods: This was a retrospective, single centre cohort study. Patient demographics were registered and preand post-operative vessel ultrasound examinations were performed at regular follow up intervals. Arteriovenous fistula outcomes in terms of vessel diameter and access flow enhancement were determined for radiocephalic, brachiocephalic, and brachiobasilic AVFs. Results: In total, 331 patients (median age 66 years, 60% male) with 366 new autologous AVFs were studied, of whom 112 patients had a previous ipsilateral vascular access (VA). Patients with a previous ipsilateral VA had a statistically significantly greater pre-operative brachial artery diameter (4.4 mm) and flow (106 mL/min), and basilic vein diameter (4.9 mm), compared with patients without a previous ipsilateral VA (4.0 mm, 54 mL/ min, and 4.3 mm, respectively). For all AVF configurations these differences gradually disappeared over three months after AVF creation. The haemodynamic changes reached a plateau at three months, and were statistically significantly accelerated in patients with a previous ipsilateral VA. There were no differences in primary failure or high flow complications between both groups. Conclusion: Arteriovenous fistulae show haemodynamic and remodelling changes up to three months postoperatively. Previous ipsilateral VAs may initiate vessel preconditioning, and accelerate the observed haemodynamic changes after AVF creation. However, this preconditioning does not result in a beneficial or detrimental effect on VA function.
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