Assessment of Effects of Upper Extremity Exercise with Arm Tourniquet on Maturity of Arteriovenous Fistula in Hemodialysis Patients

Salimi, Fereshteh; Nassiri, Gilda Majd; Moradi, Maryam; Keshavarzian, Amir; Farajzadegan, Ziba; Saleki, Mohammad; Nikpoor, Azimeh; Ghane, Massoomeh

doi:10.5301/jva.5000123

Cited by 53 publications

(71 citation statements)

References 15 publications

(14 reference statements)

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“…However, postoperative exercise programs (after AVF creation) have only shown increased flows and venous diameters in very short time periods; these changes have not been demonstrated to persist in time or to truly increase maturation . Only one randomized controlled trial has analyzed the effect of exercise after AVF creation, but this trial had severe limitations (few patients, excessive early examinations [2 weeks], and very low maturation rates) …”

Section: Introductionmentioning

confidence: 99%

“…15,17 Only one randomized controlled trial has analyzed the effect of exercise after AVF creation, but this trial had severe limitations (few patients, excessive early examinations [2 weeks], and very low maturation rates). 18 The aim of this study was to determine whether a postoperative ambulatory controlled exercise program can increase AVF maturation at 1 month.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial

Fontseré

Mestres

Yugueros

et al. 2015

Hemodialysis International

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Exercises after arteriovenous fistula (AVF) creation may help to improve maturation; however, their usefulness has only been examined in indirect, non-comparative studies or small trials. Between June 2013 and November 2014, we included all ambulatory patients with stages 5-5D chronic kidney disease who were candidates for the creation of a native AVF in our center. After surgery, all patients were randomized to an exercise group or a control group with single-blind control. At 1 month postoperatively, clinical maturation (expert nurse inspection) and ultrasonographic maturation (flow >500 mL/min, venous diameter >5 mm and depth <6 mm) were assessed in all patients. A total of 72 patients were randomized, 3 were lost to follow-up, and 69 were finally analyzed. The mean age was 66.8 years (standard deviation 13.8), 70.0% were men, and 65.2% were in pre-dialysis. After surgery (42.0% had distal AVF), the patients were randomized (31 controls, 38 exercise group). At 1 month after surgery, global clinical and ultrasonographic maturation was assessed in 88.4% and 78.3% of AVF, respectively (kappa = 0.539). Non-significant differences in clinical or ultrasonographic maturation were seen between exercise and control group (94.7% vs. 80.6%, P = 0.069; 81.6% vs. 74.2%, P = 0.459). A stepwise logistic regression was performed to control previously analyzed asymmetrically distributed confounding factors (AVF localization), revealing that the exercise group showed greater clinical, but not ultrasonographic, maturation (odds ratio [OR] 5.861, 95% confidence interval: 1.006-34.146 and OR 2.403, 0.66-8.754). A postoperative controlled exercise program after AVF creation seems to increase 1-month clinical AVF maturation in distal accesses. Furthermore, exercise programs should be taken into account, especially in distal accesses.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial

Fontseré

Mestres

Yugueros

et al. 2015

Hemodialysis International

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“…Hence, a more accurate plan for the timing of AVF creation can be established to increase the chance of commencing haemodialysis with a functioning vascular access. In addition, manoeuvres to accelerate AVF maturation such as muscular exercises with an intermittent tourniquet can also be initiated following VPS, optimizing the probability of successful and functional AVF …”

Section: Discussionmentioning

confidence: 99%

Improving haemodialysis fistula maturation following early ultrasound vascular mapping: ‘The Venous Preservation Scan’

et al. 2019

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Success and complication rates for AVF placement in patients who underwent VPR vs. RPOPS were 100% vs. 91.3% (P = 0.27) and 0 vs. 8.7% (P = 0.23) respectively. A greater proportion of AVF created following RPOPS required intervention before maturation compared to VPS (47.6% vs. 19%, P = 0.05). The median primary patency of AVF created following VPS vs. RPOPS was 492 (IQR 222, 1219) vs. 169 (IQR 116, 414) days (P = 0.02). The cumulative patency however did not differ between the 2 groups (median = 807 (IQR 499, 1308) vs. 1059 (IQR 331, 1263) days, P = 0.26) CONCLUSIONS: This small study suggests that VPS may favourably influence the survival of primary AVF and reduce the need for assisted interventions. However, confirmation with larger randomized controlled trial is warranted. This article is protected by copyright. All rights reserved.

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“…DUS measurement of AVF flow volumes is perhaps the only imaging tool that can be used to monitor the fistula even during its maturation. [2728]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis

et al. 2017

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Background:Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high “failure to mature” (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM.Materials and Methods:This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated.Results:Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively).Conclusion:Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4–6 weeks after surgery should be considered mandatory.

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Assessment of Effects of Upper Extremity Exercise with Arm Tourniquet on Maturity of Arteriovenous Fistula in Hemodialysis Patients

Abstract: We conclude that hand exercise using arm tourniquet affects most sonographic parameters which are associated with AVF maturity, and could be beneficial for acceleration of AVF clinical maturation.

Cited by 53 publications

References 15 publications

Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial

Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial

Improving haemodialysis fistula maturation following early ultrasound vascular mapping: ‘The Venous Preservation Scan’

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis

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