Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis

Ramanan, Siddharth Venkat; Attur, Ravindra Prabhu; Rao, Indu Ramachandra; Chawla, Arun; Shenoy, Srinivas Vinayak; Nagaraju, Shankar Prasad; Bhojaraja, Mohan V

doi:10.1007/s11255-021-02908-5

Cited by 11 publications

(13 citation statements)

References 20 publications

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“…A study conducted in India found a comparable finding that the primary AVF failure rate associated with interventional nephrologists was 16.6% (83/500, 95%CI: 13.6–20.11%) [ 26 ]. However, our rate was lower than that of another Indian study in which the reported rate was 25.6% (90/352, 95%CI: 21.3–30.4%) due to the differences in the definitions of primary AVF failures [ 33 ]. In the latter Indian study, primary failure was defined as an inadequate AVF obtained 3 months after the operation compared to a 6-week period in our study [ 33 ].…”

Section: Discussioncontrasting

confidence: 82%

“…Firstly, it could be due to our strict selection of study participants, especially a requirement of both arterial and venous diameters of more than 2 mm. Indeed, the arterial diameter is an important predictor for AVF maturation with an arterial diameter of < 2.0 mm highly associated with primary failure [ 33 ]. Secondly, the favorable outcome of AVF creations was also attributable to our considerably high rate of study participants who were well prepared for hemodialysis with AVF creations prior to the initiation of renal replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for our early use of AVF was to reduce the duration of using dialysis catheter in our patients which may lead to insufficient AVF maturation. In light of this, to prevent secondary failure of AVF created by nephrologists, AVF should be preserved for a longer period of time, probably more than 6 months as indicated elsewhere [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

et al. 2023

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Background Arteriovenous fistula (AVF) is the gold standard vascular access for effective hemodialysis. There is a growing interest in AVF creations performed by nephrologists to help reduce vascular surgeons’ workload and enhance the timely treatment of patients with end-stage renal disease (ESRD). However, little is known about the feasibility and effectiveness of this approach in the low-resource settings. We examined the AVF surgical success and failure rates and associated predictors as well as early complications of AVF creations by a trained nephrologist with supports from vascular surgeons in Vietnam. Methods A prospective cohort study was conducted on all adult ESRD patients at the Hemodialysis Department of Thong Nhat Hospital between April 2018 and October 2020. Information on demographic characteristics, comorbidities, and AVF creations was collected using a standardized questionnaire. All patients were followed up until 18 weeks post-surgery. Results Among 100 patients with a mean age of 61.22 ± 17.11 years old, male accounted for 54%. Common causes of ESRD included hypertension (57%) and diabetes (32%). Just more than half (52%) of them reported having an AVF creation prior to ESRD. The successful first-time AVF creation rate was 98% (13/99, 95%CI: 8.74–21.18%). The primary and secondary AVF failure rates were 13.13% (13/99, 95%CI: 8.74–21.18%) and 16.87% (14/83, 95%CI: 10.32–26.25%), respectively. Early complications included bleeding (1%) and early thrombosis of the anastomosis (2%). There was a statistically significant association between age and primary AVF failure (P = 0.005) and between operation time and secondary AVF failure (P = 0.038). Conclusions AVF creations performed by well-trained and skilled interventional nephrologists with supports from vascular surgeons can result in favorable short- and long-term outcomes. It is important to follow up older patients and those with a long operation time to detect AVF failures. A standardized AVF creation training program and practice for nephrologists is needed to increase successful rates.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

et al. 2023

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“…While endovascular and open surgical interventions are available to salvage AVFs that fail to mature and AVFs that suffer decreased flow rates over time, success rates for these salvage procedures are variable, their long-term durability is low, and the associated health care costs and burdens are necessarily increased [ 11 ]. Overall, approximately 20–60% of patients experience primary AVF failure, which underscores the need to explore strategies to improve AVF maturation and maintenance [ 12 ]. One such method is the suppression of venous neointimal hyperplasia (NIH), which interferes with AVF maturation.…”

Section: Arteriovenous Fistula Access For Hemodialysis Usementioning

confidence: 99%

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

et al. 2022

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An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis, but high failure rates restrict its use. Optimizing patients’ perioperative status and the surgical technique, among other methods for preventing primary AVF failure, continue to fall short in lowering failure rates in clinical practice. One of the predominant causes of AVF failure is neointimal hyperplasia (NIH), a process that results from the synergistic effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue. Although several systemic therapies have aimed at suppressing NIH, none has shown a clear benefit towards this goal. Localized therapeutic approaches may improve rates of AVF maturation by providing direct structural and functional support to the maturating fistula, as well as by delivering higher doses of pharmacologic agents while avoiding the adverse effects associated with systemic administration of therapeutic agents. Novel materials—such as polymeric scaffolds and nanoparticles—have enabled the development of different perivascular therapies, such as supportive mechanical devices, targeted drug delivery, and cell-based therapeutics. In this review, we summarize various perivascular therapeutic approaches, available data on their effectiveness, and the outlook for localized therapies targeting NIH in the setting of AVF for hemodialysis use. Highlights: Most systemic therapies do not improve AVF patency outcomes; therefore, localized therapeutic approaches may be beneficial. Locally delivered drugs and medical devices may improve AVF patency outcomes by providing biological and mechanical support. Cell-based therapies have shown promise in suppressing NIH by delivering a more extensive array of bioactive substances in response to the biochemical changes in the AVF microenvironment.

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“…We had a single case of a 65 year pa ent in this study so we cannot comment on the influence of age on fistula outcome at present. Other studies show propor on of diabetes in the range of 16.6%-50% and concludes its presence and pa ent age do not affect the [11][12][13] fistula outcome but shows be er outcome in male gender. This is similar to the outcome of the our study but the gender related outcome varia on can be due to small sample size in the current study.…”

Section: Discussionmentioning

confidence: 89%

Outcomes of Arterio-venous Fistula Reconstruction in Chronic Kidney Disease Patients Presenting in Tertiary Care Hospital in Eastern Nepal

Thakur¹,

Yadav²,

Agrawal³

2022

Birat J. Health Sci.

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Introduction: Renal Replacement Therapy is the treatment modality for the chronic kidney disease (CKD) which ranges from hemodialysis, peritoneal dialysis to the renal transplantation, the latter being the best form of treatment. But, renal transplantation is available at limited centers only so hemodialysis is the most commonly used treatment modality of chronic kidney disease which requires a vascular access. But there are limited vascular surgeons in the region so most of the arterio-venous (AV) fistulas are reconstructed by Urologist/Surgeons exposed to vascular surgery during their residency/training period. Objectives: To know the factors influencing the site selection, to assess the success rate and to document the complications of AV fistula reconstruction. Methodology: This is a hospital based prospective observational study conducted in the Birat Medical College – Teaching Hospital, Morang, Nepal from June 2021 to May 2022. We included the CKD patients requiring vascular access for hemodialysis with Color Doppler available for vascular mapping. Patients with brachial sites previously used and without Color Doppler were excluded from the study. AVF was reconstructed under local anesthesia and outcomes were recorded. Results: Thirty one patients of CKD underwent AVF reconstruction over the study period. Male and female ratio was 1.33 (57% and 43%). The mean age was 42.14 ± 11.34 years (Range 26-65 years). The mean diameter of radial artery (RA) and cephalic vein (CV) at wrist were 1.92 ± 0.56mm and 1.91 ± 0.20 mm respectively. Similarly, the mean diameter of brachial artery (BA) and CV at elbow were 3.66 ± 0.87mm and 3.57 ± 0.55 mm respectively. The fistula reconstructed were Lt RC (radio-cephalic) – 50% (14), Lt BC (brachio-cephalic) -35.71% (10) and Lt BB ( brachio-basalic) - 14.29% (4) respectively. Complications occurred in 4 cases (14.28%). Conclusion: Selection of type of AVF creation is influenced by the vessel diameter as well as previous fistula surgery status and AVF access for hemodialysis has adequate patency with acceptable complications.

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Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis

Cited by 11 publications

References 20 publications

Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

Outcomes of Arterio-venous Fistula Reconstruction in Chronic Kidney Disease Patients Presenting in Tertiary Care Hospital in Eastern Nepal

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