Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access

Abstract

With a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69%) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83%) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.

Arteriovenous Fistula Construction with the VasQ™ External Support Device: A Pilot Study

“…These early results from a limited size study show promise with good sustained performance characteristics of the VasQ™ implant where the venous flow rates exceed those reported by Robbin et al as necessary for efficient dialysis in more than 95% of AVFs (13). Our results (ranging from 50%-70%) exceed those of the available literature for primary patency rates reported at between 40% and 60% (3) and where between 15%-40% of AVFs require assistance revision (14)(15)(16). Comparison with implant-enhanced fistulas (the Optiflow Patency and the Maturation [OPEN] study) (17)(18)(19)(20)(21) show significantly improved maturation and flow rates with comparable patency rates.…”

Nonmaturation of arm arteriovenous fistulas for hemodialysis access: A systematic review of risk factors and results of early treatment

“…Of these, 37 were excluded based on previously described criteria, and 33 studies were selected for final inclusion. These were 12 treatment papers [14][15][16][17][18][19][20][21][22][23][24][25] and eight preclinical articles, 9,[26][27][28][29][30][31][32] of which seven more were discarded after critical appraisal. So, one preclinical study finally remained (this is explained further subsequently).…”

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…281,296,297 Additional investigations such as DUS or DSA are indicated if physical examination by experienced staff determines maturation failure 6 weeks after AVF creation or poor prognostic signs (faint or absent thrill, complete access collapse proximally, discontinuous bruit, high pitch continuous systolic audible bruit, pulsatile AVF, small diameter or poorly defined vein, excessive depth, large accessory/collateral veins). 132,288,298 Non-matured AVFs frequently have one or more potentially remediable problems, and up to 80% can be salvaged after surgical or endovascular correction, 299,300 although thereafter cumulative survival rates are decreased and require more secondary interventions to maintain patency. 301 The most common causes of non-maturation are venous, arterial or anastomotic stenosis, competing veins or large patent branches, and excessive depth from the skin.…”