Predictors of Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula in a Cohort of Asian Patients

Li, Hai‐Lei; Chan, Yiu Che; Cui, Dong-Zhe; Liu, Jingsi; Wang, Mingchi; Li, Ning; Pai, Pearl; Cheng, Swk

doi:10.1016/j.avsg.2019.12.029

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…Although previous studies have reported that female sex was associated with an increased risk of failure of maturation [6], our study showed no significant differences according to sex in maturation (p=0.400) or in cephalic vein size (p=0.597) and TTF (p=0.936), both of which were in-…”

Section: Discussioncontrasting

confidence: 99%

“…Most previous reports assessing the association between failure of maturation and the size of the vein used showed findings consistent with our results [6,7]. Our study results lead us to recommend a cephalic vein of ≥2.45 mm (AUC, 0.70) in order to optimize the functional maturation outcomes.…”

Section: Discussionsupporting

confidence: 91%

“…Nonetheless, the high primary AVF maturation failure rate (20%–50%) remains a major obstacle to the use of AVFs [ 3 , 4 ]. Studies have recommended various optimal ranges of vessel size the maturation of radiocephalic AVFs (RCAVFs) [ 5 , 6 ]. However, no agreed-upon guideline regarding vessel size for RCAVFs has been established.…”

Section: Introductionmentioning

confidence: 99%

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Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

Kwon

Cho

Kang

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: This study aimed to assess the effect of vessel size and flow characteristics on the maturation of autogenous radiocephalic arteriovenous fistulae (RCAVFs). Methods: We retrospectively reviewed records of patients undergoing RCAVF creation at a single medical center from January 2013 to December 2019. Operative variables were compared between patients whose fistulae matured and those whose fistulae failed to mature. Results: Overall, 152 patients (33 of whom were women) with a mean age of 62.6±13.6 years underwent RCAVF creation; functional maturation was achieved in 123. No statistically significant differences were observed between patients in whom maturation was or was not achieved in terms of the following variables: female sex (20.3% vs. 25.0%), radial artery size (2.5 vs. 2.4 mm), and pulsatility index (0.69 vs. 0.62). Low intraoperative transit time flowmetry (TTF; 150.4 vs. 98.1 mL/min) and small vein size (2.4 vs. 2.0 mm) were associated with failure of maturation. The best cutoff diameter for RCAVF TTF and cephalic vein size were 105 mL/min and 2.45 mm, respectively. Conclusion: In patients who undergo RCAVF creation, vein diameter on preoperative ultrasonography and intraoperative TTF are predictors of functional maturation. We identified an intraoperative TTF cutoff value that can be used for intraoperative decision-making.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

Kwon

Cho

Kang

et al. 2020

Korean J Thorac Cardiovasc Surg

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“…The study had several limitations that may affect the interpretation of the results. First, the NHIRD does not include detailed information on smoking habits [ 27 ], the arterial or venous diameter before the creation of AVAs [ 28 ], the experiences of surgeons, the anastomosis type of the AVFs [ 29 ], the sites of AVAs, the preoperative radial artery volume flow [ 30 ], early referral for the creation of AVAs [ 31 ], and the use of far-infrared therapy [ 32 ]. These limitations may have affected the patency of the AVAs.…”

Section: Discussionmentioning

confidence: 99%

Bridge of Tunneled Cuffed Catheter as a Risk for Future Arteriovenous Fistulae Failure

Huang

Lin

et al. 2022

JCM

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Background: A clinically tunneled cuffed catheter (TCC) for hemodialysis (HD) is often inserted into end-stage renal disease patients, who have an immature or no arteriovenous fistula (AVF), for the performance of HD to relieve uremic syndrome or to solve uncontrolled fluid overload, hyperkalemia, or metabolic acidosis. The catheter is primarily regarded as a bridge until the AVF matures and can be cannulated for HD. However, the effect of the bridge of the TCC on the future patency of AVFs remains elusive. Methods: This nationwide population-based observational study compared the hazards of AVF failure and the time to AVF failure. We enrolled 24,142 adult incident patients on HD, who received HD via AVFs for at least 90 days between 1 January 2010 and 31 December 2015. The subjects were divided into two groups, according to the history of TCC, and were followed-up until the failure of the AVF, mortality, or the end of the study. A propensity score-matched analysis based on 1:1 matching of age, sex, and baseline comorbidities was utilized to reduce bias and confounding variables. Results: A Kaplan–Meier survival curve revealed that patients with and without a history of TCC had significantly better AVF survival rates (log-rank test; p < 0.001). A history of TCC was independently associated with a higher risk of new AVF or AVG creation due to AVF failure, after the adjustment of the Charlson comorbidity index score (corresponding adjusted hazard ratios of 2.17 and 1.52; 95% confidence intervals of 1.77–2.67 and 1.15–1.99). For the impact of time on AVF failure, patients with a TCC bridge had a significantly higher incidence of new AVF creation during the first year after the AVF cannulation. Conclusion: A history of a TCC bridge was an independent risk factor for AVF failure and the time of AVF failure was significantly higher during the first year after the fistula cannulation in the TCC bridge group.

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“…The effect of diabetes mellitus on the maturation of AVF is controversial. 25 leading to an increased risk of atherosclerosis and peripheral vascular disease. It is suggested that attention should be paid to diabetes and its complications before the establishment of AVF.…”

Section: Discussionmentioning

confidence: 99%

Maturation and survival of arteriovenous fistula: The challenge starts from the preoperative assessment stage

Gan

Shao

et al. 2021

Seminars in Dialysis

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Background It is necessary to assess the association between the preoperative indicators and the maturation and survival of arteriovenous fistula (AVF). Methods We retrospectively identified 236 patients with a new AVF created between 2016 and 2018 in our Dialysis Center. Results Multivariate Logistic regression showed that preoperative arterial diameter (odds ratio [OR] = 1.452, 95% confidence interval [CI] [1.233, 1.710], p < 0.001), preoperative venous diameter (OR = 1.296, 95% CI [1.166, 1.477], p < 0.001), left ventricular ejection fraction (LVEF) (OR = 1.187, 95% CI [1.103, 1.277], p < 0.001), and diabetes mellitus (OR = 0.245, 95% CI [0.107, 0.560], p = 0.01) were independent influential factors for AVF maturation. Two years after the AVF surgery follow‐up, multivariate Cox proportional‐hazards model showed that the preoperative arterial diameter (OR = 0.510, 95% CI [0.320, 0.813], p = 0.005), preoperative venous diameter (OR = 0.940, 95% CI [0.897, 0.985], p = 0.010) and diabetes mellitus (OR = 1.785, 95% CI [1.117, 2.855], p = 0.016) was prognostic factors of AVF survival. The Kaplan–Meier method showed that the primary survival of AVF in patients with different preoperative arterial diameter was statistically significant (log‐rank χ2 = 15.415, p < 0.001), while the secondary survival was not statistically significant (log‐rank χ2 = 0.131, p = 0.717). Conclusion In our cohort, the preoperative arterial and venous diameter and diabetes mellitus were independent influential factors for AVF maturation and prognostic factors of AVF survival. However, the preoperative LVEF only associated with the maturation of AVF. Meanwhile, smaller arterial diameter (≤2.15 mm) was associated with AVF maturation failure, but did not impact secondary survival of AVF.

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Predictors of Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula in a Cohort of Asian Patients

Cited by 11 publications

References 26 publications

Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

Bridge of Tunneled Cuffed Catheter as a Risk for Future Arteriovenous Fistulae Failure

Maturation and survival of arteriovenous fistula: The challenge starts from the preoperative assessment stage

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