Association of Maturation Period Blood Pressure with Dialysis Access Patency

Abstract

Problematic dialysis vascular access is a major health issue. The purpose of this study was to evaluate for potentially modifiable factors associated with access patency, particularly, the association of early postoperative, or maturation period, blood pressure with patency. A retrospective review was performed of patients who had undergone placement of an arteriovenous fistula or graft. Demographic, operative, and postoperative factors were evaluated for possible association with access primary patency using univariate and multivariate Cox regression analyses. Seventy-three patients over a 3-year review period were examined. Overall analysis showed a significant association of absence of peripheral vascular disease, aspirin use, and absence of previous permanent dialysis access with higher primary patency rates. Fistula subgroup analysis showed that higher blood pressure during the maturation period relative to preoperative blood pressure was associated with lower patency rates. For grafts, race was significantly associated with patency, with blacks having higher patency rates than whites. Multiple clinical factors were found to have a significant association with dialysis access primary patency. The finding of an association of maturation period blood pressure with fistula patency suggests that the maturation period environment, specifically hemodynamics during this time, may play an important role in dialysis access patency.

Outcomes of Arteriovenous Grafts Following Simultaneous Thrombectomy and Stent Graft Placement Across the Venous Anastomosis

“…At odds with these findings by Gibson Only the variables with p < 0.3 in univariate analysis were included in multivariate analysis. AVF) in 73 dialysis patients and reported a higher primary patency rate in Blacks following AVG creation (14). The reason for this discrepancy is unclear; however, the much larger sample size in the Gibson et al study favors our study finding.…”

A new method to determine anastomosis angle configuration for arteriovenous fistula maturation

“…Some other researchers have tried to emphasize the associations between characteristics of ESRD patients (such as positive history of hypertension and/or diabetes mellitus (DM)) with the AVF failure result (19, 21-22), which overall can be useful in predicting surgical complications, specially reasons of nonmaturation in AVF after VA operation. Also, when data mining techniques are applied, some “inverse effects” of these characteristics on the AVF are revealed, such as the unusual effect of hemoglobin (HB) level in smoking HD patients (23) or proper behavior of non-hypertensive ESRD patients towards their AVF maturation versus risk of positive history of Blood Pressure (BP) (24-25). Moreover, these studies provide insight that helps constructing a system for VA surgeons (26) to provide them with hints about adjusting preoperative factors of ESRD patients, such as HB level (7, 11), DM (19, 27-28), triglyceride and phosphate (29), and BP (30), to increase the likelihood of AVF maturation.…”

Comparison Of The Early-term Complications And Patency Rates Of The Standard (parachute) And Diamond-shaped End-to-side Anastomosis Techniques In Arteriovenous Fistulas Created For Hemodialysis

“…These include age, sex, comorbidities, history of PVD, ASA use, and history of previous permanent dialysis access placement, anatomic vessel structure, localisation of anastomosis, surgical experience, and selection of appropriate technique. [13][14][15] The most important factor among them is the use of different surgical techniques. 9 Despite being variable in clinical applications, the endto-side anastomosis technique is applied with 4quadrant, 2-quadrant, or parachute techniques.…”

“…Fistulas created with small vessels (<1.5-2 mm) are at increased risk of occlusion. 14,22 In this study, no procedure was performed in veins with diameter less than 2 mm. Three patients were found to have a vein diameter less than 2 mm and a more proximal AVF was established in these cases.…”