Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single‐centre experience

Lee, Kian-Guan; Chong, Tsung Wen; Goh, Nicholette; Achudan, Shaam; Tan, Yuqi; Tan, Ru Yu; Choong, Hui Lin; Tan, Chieh-Suai

doi:10.1111/nep.12788

Cited by 24 publications

(28 citation statements)

References 31 publications

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“…In Leeja et al the median age of all patients was 64 years, and 47% of them were older than 65 years. According to their study, no link was found between the age of patients over 65 and the number of AVF closures (ligations) 61 .…”

Section: Discussionmentioning

confidence: 92%

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Jurić

Zibar

2019

Rad Hrvatske akademije znanosti i umjetnosti

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Aims: To examine the proportion of patients with thrombosis or surgical ligation of arteriovenous fistula (AVF) after kidney transplantation (TX) and to explore the time passed after the TX until the loss of AVF function. Patients and methods: The study design was historical cohort study. The study included all 123 patients (57.7 % men, median age 58 years, from 34 to 79) that underwent kidney TX in the University Hospital Centre Osijek during the first 10 years of practicing that kind of surgery in the hospital. The data on AVF function, thrombosis or ligation were undertaken from medical records, along with demographics (age, gender, time after TX). The data were presented descriptively and after statistical analysis that was performed using SPSS (version 17.0). Results: FunctionalAVF immediately prior to TX was found in 78 % of the patients. The AVF was still functional in 39.84 % of all patients for 3 years (median, interquartile range, IQR 0 -3) after TX. AVF thrombosis happened in 17.89 %, while surgical ligation was performed in 20.33 % of all patients. The most common reason for ligation was increased risk of heart failure (in 75 % of the ligations), followed by aneurysmatic dilatation and arm swelling. Median time after TX to thrombosis or ligation of AVF was 2 years, IQR 0 -3. Thrombosis or ligations were significantly more frequent in women. The outcome of AVF after kidney TX was not related to the patient's age. Conclusion: AVF after kidney TX often became nonfunctional, either after spontaneous thrombosis or after surgical ligation, which was required for increased heart failure risk in the majority of the cases. Sažetak:Arterijskovenskih fistula nakon bubrežnog presađivanja u Kliničkom bolničkom centru Osijek Cilj: Istražiti udio ispitanika u kojih je nakon bubrežnog presađivanja (transplantacije, TX) došlo do tromboze ili ligacije arterijskovenske fistule (AVF) te istražiti vrijeme nakon TX-a u kojemu je došlo do gubitka funkcije AVF-a. Ispitanici i postupci: Istraživanje je ustrojeno kao kohortno povijesno istraživanje.Uključeno je svih 123 bolesnika (57,7 % muških, medijana dobi 58 godina, od 34 do 79) kojima je bubrežni presadak transplantiran u Kliničkom bolničkom centru Osijek tijekom prvih 10 godina otkako se u toj bolnici vrši bubrežni TX. Iz medicinskih zapisa preuzeti su podaci o funkciji AVF-a, trombozama i ligacijama, kao i demografski podatci (dob, spol, vrijeme nakon TX-a). Podaci su prikazani deskriptivno i analitički, a statistički obrađeni pomoću SPSS-a (inačica 17.0). Rezultati: AVF neposredno prije TX-a imalo je 78 % bolesnika. Još uvijek funkcionira u 39,84 % svih ispitanika, 3 godine (medijan, interkvartilni raspon, IQR od 0 do 3) nakon TX-a. Tromboza AVF-a je nastupila u njih 17,89 %, a ligacija je izvedena u 20,33 % svih ispitanika. Najčešći razlog ligacije AVF-a u našem istraživanju bio je srčano opterećenje (u 75 % ligacija), zatim aneurizmatična dilatacija AVF-a te otok ruke. Vrijeme nakon TX-a do tromboze ili ligacije bilo je medijana 2 godine (IQR 0 -3). Tromboza ili liga...

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Section: Discussionmentioning

confidence: 92%

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Jurić

Zibar

2019

Rad Hrvatske akademije znanosti i umjetnosti

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“…The arteriovenous fistula was the predominant method of access among the patients of hospital A (69.66%) and the dual lumen catheter among the patients of hospitals C and B (85.71 and 82.67%). The indication of arteriovenous fistula has proven to be of great benefit to patients undergoing hemodialysis 9 , with catheter use being associated with a higher incidence of infections, hospitalizations, and increased patient mortality 10 .…”

Section: Discussionmentioning

confidence: 99%

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals

Lima

2018

Rev. Latino-Am. Enfermagem

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Objective:to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. Method:quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. Results:the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the “installation and removal of hemodialysis fistula access” caused a significantly lower economic impact compared to “installation and removal of hemodialysis catheter access”. Conclusion:with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

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“…Successful RCAVF was defined as fistula that matured and afforded successful cannulation and conventional intermittent hemodialysis of 4 h with extracorporeal blood flow of at least 200 mL/min. 3,9,10…”

Section: Methodsmentioning

confidence: 99%

Preoperative cephalic vein diameter and diabetes do not limit the choice of wrist radio-cephalic arteriovenous fistula

Hou

et al. 2019

J Vasc Access

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Aim: To identify predictors that affect initial maturation of new wrist radio-cephalic arteriovenous fistula and evaluate the clinical effects of the ipsilateral mid-forearm radio-cephalic arteriovenous fistulas creation in the event of first wrist radio-cephalic arteriovenous fistula failure. Methods: We performed a retrospective review of all patients who underwent first wrist radio-cephalic arteriovenous fistula creation between September 2016 and May 2018. Currently, we prefer to re-create an ipsilateral mid-forearm radio-cephalic arteriovenous fistula when the first wrist radio-cephalic arteriovenous fistula fails. Predictors of successful radio-cephalic arteriovenous fistulas were identified using univariate and multivariate analyses. Kaplan–Meier survival analysis and log-rank test were used to calculate successful radio-cephalic arteriovenous fistula rates. Results: Univariate analysis showed that predictive factors for successful wrist radio-cephalic arteriovenous fistula include larger preoperative cephalic vein diameter ( p = 0.001) and non-diabetic kidney disease ( p = 0.007). Multivariate binary logistic regression analysis revealed cephalic vein diameter ⩾2 mm (odds ratio = 4.55, 95% confidence interval = (1.49–13.92), p = 0.008) and non-diabetic kidney disease (odds ratio = 4.22, 95% confidence interval = (1.38–12.88), p = 0.011) to be independent predictors for successful radio-cephalic arteriovenous fistula. We re-created ipsilateral mid-forearm radio-cephalic arteriovenous fistulas in 15 patients among the 21 failed wrist radio-cephalic arteriovenous fistulas; all these arteriovenous fistulas maintained clinical maturation following up for 1–2 years. Conclusion: Small cephalic vein diameter (<2 mm) and diabetes were independent risk factors for failed wrist radio-cephalic arteriovenous fistulas, but this risk could be overcome by aggressive ipsilateral mid-forearm radio-cephalic arteriovenous fistula to address a failed first attempt. Cephalic vein diameter is more important during the maturation stage, and once maturation has occurred, diabetes has an additive role in determining the patency of wrist radio-cephalic arteriovenous fistula. The “wrist RCAVF first, ipsilateral mid-forearm RCAVF second” strategy is the most clinically significant message of our study.

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Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single‐centre experience

Abstract: Arteriovenous fistula can be successfully created in most incident haemodialysis patients. Routine vein mapping is not necessary if veins are suitable on physical examination alone, and vein sizes of <2 mm on ultrasound is not associated with lower AVF maturation rate.

Cited by 24 publications

References 31 publications

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals

Preoperative cephalic vein diameter and diabetes do not limit the choice of wrist radio-cephalic arteriovenous fistula

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