Outcomes of Initial Hemodialysis Access Surgery in an Asian Population

Thwaites, Stephen; Robless, Peter

doi:10.5301/jva.5000064

Cited by 4 publications

(9 citation statements)

References 29 publications

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“…Such arteriopathy inhibits the adaptive dilatation required for AVF maturation. The overall one-year assisted primary patency of forearm AVF among this cohort was 40%-significantly lower than the overall rate of 53.95% [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis

Yoo

Yoon

Jun

2014

VSI

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Purpose:Preservation of adequate vascular access is of vital importance for patients undergoing chronic dialysis in renal failure. The aim of this study is to evaluate the successful access rate and risk factors of arteriovenous fistula (AVF) in the arm for dialysis at a single center.Materials and Methods:Patients undergoing vascular access operation between January 2006 and December 2011 were retrospectively identified.Results:A total of 362 vascular access operations were performed. There were 338 autologous AVFs (93.4%) and 24 prosthetic grafts (6.6%). Men comprised 58.3% of all subjects. Mean age was 59.5±14.7 years. There were 187 diabetes mellitus patients (51.7%). There was a mean duration of 70.3±21.1 days between access creation to first cannulation. Overall successful access rate for dialysis was 95.9%. Of 338 autologous AVFs, 326 patients had patent AVFs for dialysis (96.4% surgical success rate), while 21 of 24 prosthetic grafts were patent (87.5% surgical success rate). A total of 141 patients (38.9%) came to surgery with preoperative central venous catheters (CVC) of which 130 (35.9%) AVFs had a patent fistula in the arm. The only risk factor related to successful access rate of AVF was preoperative CVC placement (P=0.012).Conclusion:Successful vascular access rate was 95.9%. The only risk factor related to patent access of AVF was preoperative CVC placement. At least 6 months prior to expected dialysis, AVF surgery is recommended, which may overcome the challenge of co-morbid conditions from having a preoperative CVC.

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Section: Discussionmentioning

confidence: 99%

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis

Yoo

Yoon

Jun

2014

VSI

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“…Of the remaining 47 articles, 6 were excluded because they were not human experiments, 8 studies were deleted because they selected unsuitable inclusion criteria, 7 articles were excluded as only the upper-arm group or forearm group in their study, 12 articles were excluded as data cannot be converted or extracted in the study, and 2 was removed because they were literature reviews. Finally, a total of 12 studies [16][17][18][19][20][21][22][23][24][25][26][27] were deemed eligible for inclusion in this review (Figure 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

The association between the locations of arteriovenous fistulas and patency rates: A systematic review and meta‐analysis

Gan

Shao

Zhu

et al. 2022

Seminars in Dialysis

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Background The arteriovenous fistulas (AVF) continue to be the most prevalent type of vascular access for hemodialysis (HD). However, the appropriate locations of AVF are controversial. We conducted the meta‐analysis to investigate the differences in patency between upper‐arm and forearm AVF. Methods PubMed, EMBASE, CENTRAL, and ISI Web of Science were searched to identify studies with differences in AVF patency at different locations. Reviewers searched the database, screened studies according to inclusion criteria, and conducted Meta‐analysis. Results A total of 12 studies involving 3437 patients were selected. Pooled data showed that primary patency (PP) of AVF were higher in upper‐arm than forearm at 1 and 2 years (odds ratio [OR] = 1.54, p = 0.0005; OR = 2.45, p = 0.001), but the differences in cumulative patency (CP) were not statistically significant at 1 and 2 years (OR = 2.10, p = 0.08; OR = 2.16, p = 0.1). The differences in PP and CP between upper‐arm and forearm AVF in patients older than 65 years were not statistically significant at 1 (OR = 1.61, p = 0.05; OR = 2.05, p = 0.17) and 2 years (OR = 3.40, p = 0.13; OR = 1.38, p = 0.16). In Asian patients, the differences in PP and CP between upper‐arm and forearm AVF were not statistically significant at 1 (OR = 1.17, p = 0.41; OR = 1.02, p = 0.94) and 2 years (OR = 2.95, p = 0.08; OR = 1.23, p = 0.41). Conclusions In this study, the CP of upper‐arm and forearm AVF was similar in overall population. There was no difference in PP and CP of AVF between upper‐arm and forearm in Asian population or the elderly. The forearm AVF could be consider to be the first choice. for Asian patients or the elderly.

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“…The reported rate of AVF creation rate in new incident HD patients was 95%-98%. 10,11 The commonest type of AVF is radio-cephalic AVF accounting for 58.6%-67.5%. 10,12 Of all AVFs created, 54%-78% were functional, which was greater than the recommended prevalent functional AVF placement rates of at least 65%, suggested by the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline.…”

Section: Tunneled Dialysis Cathetermentioning

confidence: 99%

“…Primary patency rates at 1 year were reported to be 33%-51%, while cumulative patency rates were 54%-74%. [10][11][12][13]…”

Section: Tunneled Dialysis Cathetermentioning

confidence: 99%

“…Timely AVF creation in patients approaching ESRD remains challenging. Although the success rates of autogenous AVF creation have been comparable with international standards, 10,11 the low rate of pre-emptive permanent vascular access placement has been a long-standing problem in Singapore. Studies across different institutions showed that up to 80% of patients commenced dialysis without a permanent vascular access.…”

Section: Vascular Access Creationmentioning

confidence: 99%

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Current state of vascular access in Singapore

et al. 2019

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This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

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Outcomes of Initial Hemodialysis Access Surgery in an Asian Population

Abstract: In our Asian population, we have demonstrated AVF patency rates equivalent to those of international centers. We now face the challenge of achieving a higher rate of pre-emptive AVF placement with a subsequent reduction in CVC use.

Cited by 4 publications

References 29 publications

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis

The association between the locations of arteriovenous fistulas and patency rates: A systematic review and meta‐analysis

Current state of vascular access in Singapore

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