Factors Influencing Maturation Time of Native Arteriovenous Fistulas

Dunn, Joie; Herscu, Gabriel; Woo, Karen

doi:10.1016/j.avsg.2014.11.026

Cited by 24 publications

(26 citation statements)

References 14 publications

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“…12 Our maturation time and cumulative survival are in accordance to what have been previously described elsewhere. 2,11,14 Several features have been associated with FUHD. Patients with higher tobacco consumption and patients who had their AVF on the same side of HD catheter have been linked as potential risk factors for FUHD.…”

Section: Discussionmentioning

confidence: 99%

“…Age, peripheral vascular disease, and need of assistance have also been linked as well. 11,12,14,15 These patient characteristics and serum albumin are included in the six-month mortality-predicting model developed by Cohen et al 22 As maturation time for an AVF is mostly between 2 and 6 months, 11e13 it might be reasonable to use an instrument that can estimate the possibility of death before an AVF fistula can be used. We found that patients with higher chances of death within 6 months calculated by this model were statistically significantly associated with AVF unsuccessful use.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico

Martínez-Mier¹,

Camargo-Diaz²,

Urbina-Velazquez³

et al. 2020

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico

Martínez-Mier¹,

Camargo-Diaz²,

Urbina-Velazquez³

et al. 2020

Annals of Vascular Surgery

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“…Another limitation of our investigation that may explain the inaccuracy of prediction in BFV after VA maturation, is that we assumed a constant 40 days time interval for AVF maturation for the whole patient population. While this assumption may be reasonable for most of cases, it could be erroneous for some of them, like diabetic patients, who have slower VA maturation [23]. Finally, the results of our usability test are also limited, in some way, by the small number of AVFs examined.…”

Section: Discussionmentioning

confidence: 99%

Clinical use of computational modeling for surgical planning of arteriovenous fistula for hemodialysis

Bozzetto

Rota

Vigo

et al. 2017

BMC Med Inform Decis Mak

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BackgroundAutogenous arteriovenous fistula (AVF) is the best vascular access (VA) for hemodialysis, but its creation is still a critical procedure. Physical examination, vascular mapping and doppler ultrasound (DUS) evaluation are recommended for AVF planning, but they can not provide direct indication on AVF outcome. We recently developed and validated in a clinical trial a patient-specific computational model to predict pre-operatively the blood flow volume (BFV) in AVF for different surgical configuration on the basis of demographic, clinical and DUS data. In the present investigation we tested power of prediction and usability of the computational model in routine clinical setting.MethodsWe developed a web-based system (AVF.SIM) that integrates the computational model in a single procedure, including data collection and transfer, simulation management and data storage. A usability test on observational data was designed to compare predicted vs. measured BFV and evaluate the acceptance of the system in the clinical setting. Six Italian nephrology units were involved in the evaluation for a 6-month period that included all incident dialysis patients with indication for AVF surgery.ResultsOut of the 74 patients, complete data from 60 patients were included in the final dataset. Predicted brachial BFV at 40 days after surgery showed a good correlation with measured values (in average 787 ± 306 vs. 751 ± 267 mL/min, R = 0.81, p < 0.001). For distal AVFs the mean difference (±SD) between predicted vs. measured BFV was −2.0 ± 20.9%, with 50% of predicted values in the range of 86–121% of measured BFV. Feedbacks provided by clinicians indicate that AVF.SIM is easy to use and well accepted in clinical routine, with limited additional workload.ConclusionsClinical use of computational modeling for AVF surgical planning can help the surgeon to select the best surgical strategy, reducing AVF early failures and complications. This approach allows individualization of VA care, with the aim to reduce the costs associated with VA dysfunction, and to improve AVF clinical outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0420-x) contains supplementary material, which is available to authorized users.

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“…Outward remodeling is thought to be mediated by the venous endothelium and adventitia that sense hemodynamic forces and integrates these forces to allow successful adaption without loss of luminal area and vessel patency [21, 24, 44, 45]. Venous diameter expansion is a critical element of outward remodeling and predicts clinical success for both AVF and vein grafts [46–48].…”

Section: Mechanisms Contributing To Avf Maturation and Failurementioning

confidence: 99%

“…Furthermore, a recent systematic review and meta-analysis reported that the primary patency rates of AVF were 60% at 1 year and 51% at 2 years, with secondary patency rates of 71% at 1 year and 64% at 2 years, clearly suboptimal for a permanent treatment [23]. Although there are conflicting results regarding sex influence on AVF failure, most studies demonstrated that women have prolonged maturation time and decreased patency rate [17, 24, 25]; early thrombosis was also associated more frequently with women [26]. Controversially, AVF may not be favored for HD access in older patients [27–29].…”

Section: Introductionmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

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Factors Influencing Maturation Time of Native Arteriovenous Fistulas

Cited by 24 publications

References 14 publications

Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico

Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico

Clinical use of computational modeling for surgical planning of arteriovenous fistula for hemodialysis

Future research directions to improve fistula maturation and reduce access failure

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