Obesity and Hemodialysis Vascular Access Failure

Plumb, Troy J.; Adelson, Anthony B.; Groggel, Gerald C.; Johanning, Jason M.; Lynch, Thomas G.; Lund, Bryce

doi:10.1053/j.ajkd.2007.06.010

Cited by 37 publications

(25 citation statements)

References 9 publications

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“…A small number of case reports have suggested that excessive soft tissue compressing venous outflow may directly lead to failure in extremely obese patients. Nevertheless, patients with BMI of 35 kg/m 2 have an increased risk for poor AVF function, but no differences were found for those with a BMI lower or higher than 27 kg/m 2 , 25 which indicates the need careful preoperative assessment of vessels is necessary. The existence of obesity was not determined among our patients, because the mean value for BMI was 24.6 kg/m 2 , and this parameter had no significant impact on the functioning of the AVF.…”

Section: Discussionmentioning

confidence: 98%

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience

Stolić

Trajković

Kostić³

et al. 2017

Hemodialysis International

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Section: Discussionmentioning

confidence: 98%

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience

Stolić

Trajković

Kostić³

et al. 2017

Hemodialysis International

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“…16 The evidence suggests that only "super obesity" affects AVF patency and that good results can be achieved in obese patients with awareness of specific factors (outflow occlusion, need for superficialization procedures) and careful preoperative assessment of vessels.…”

Section: Patient Factorsmentioning

confidence: 99%

Factors affecting the patency of arteriovenous fistulas for dialysis access

Smith

Gohil

Chetter

2012

Journal of Vascular Surgery

215

174

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“…An increase in the risk of primary failure appears to be associated with unplanned surgery, delayed access to the nephrologist, experience of the surgical team, vessel diameter, cardiovascular disease, diabetes, and age. 2,10,[17][18][19][20][21][22][23][24][25][26][27][28][29] Arteriovenous fistulas undergo vascular structural changes in time in accordance with shifts in hemodynamic parameters. Arteries and veins that are morphologically sound, nonatherosclerotic, and especially large in diameter have been shown on multiple occasions to be predictive of fistula success.…”

Section: Discussionmentioning

confidence: 99%

Can primary failure of arteriovenous fistulas be anticipated?

Genek

Altay

Ünek

et al. 2014

Hemodialysis International

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Primary failure, early thrombosis, and inadequate maturation are the main complications encountered in arteriovenous fistulas. Doppler ultrasonographic assessment of flow-mediated dilatation (FMD) is currently used for the early diagnosis of atherosclerosis. Clinical experience in the use of FMD for preoperative assessment of vasculature is rather limited; therefore, we sought to elucidate the relationship between preoperative FMD and primary failure of the fistula. Thirty-three patients with end-stage renal disease who were admitted to our hospital between January and July 2005 were included in our study. Medical histories were established and the internal diameter, wall thickness, peak systolic flow rate, and resistive index (RI) were measured in the cephalic vein and radial and brachial arteries. Flow-mediated dilatation and nitrate-mediated dilatation (NMD) of the brachial artery were assessed. Fistulas were evaluated 48 hours and 30 days postoperatively. Brachial arterial internal diameter was lower in all fistulas that developed primary failure in 48 hours (0.4 ± 0.07 cm vs. 0.35 ± 0.07 cm, P = 0.016). The radial artery RI was found to be significantly elevated in fistulas with both early (48-hour) and late-term (30-day) failure (0.9 ± 0.08 vs. 0.68 ± 0.3, P = 0.01, and 0.86 ± 0.8 vs. 0.67 ± 0.3, P = 0.038, respectively). The brachial artery peak systolic flow rate was significantly reduced in patients in the radiocephalic fistula group that developed early and late-term failure (42.9 ± 12 cm/sec vs. 68.4 ± 10 cm/sec, P = 0.01, and 44.1 ± 13 cm/sec vs. 57.7 ± 16 cm/sec, P = 0.038, respectively). Our study, constrained by a smaller, older patient group, was unable to show a statistically significant correlation between FMD, NMD, and fistula success. Any single parameter may not be sufficient to assess vascular health preoperatively. A multifactorial approach incorporating parameters evaluating arterial and venous function might be more effective in predicting fistula success. Further studies on larger patient groups may indeed demonstrate the value of these assessments.

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Obesity and Hemodialysis Vascular Access Failure

Cited by 37 publications

References 9 publications

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience

Factors affecting the patency of arteriovenous fistulas for dialysis access

Can primary failure of arteriovenous fistulas be anticipated?

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