The Impact of Patient Demographics, Anatomy, Comorbidities, and Peri-operative Planning on the Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula

Kordzadeh, Ali; Askari, Alan; Hoff, Mekhola; Smith, Valerie A.; Panayiotopoulos, Y.P.

doi:10.1016/j.ejvs.2017.01.015

Cited by 32 publications

(35 citation statements)

References 25 publications

(23 reference statements)

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“…15,19,31,33 In addition, tourniquet-derived preoperative vein diameters are used in some studies 14,15,22,29 but not in others. 17,21,33,34 Tourniquet-derived measurements have been shown to increase outflow vein measurements by >30% in some series, 37 and perioperative assessment after brachial plexus block has demonstrated that size increases from preoperative tourniquet-derived diameters up to an additional 0.96 mm. 38 As a result, a wide range of vessel size criteria have been proposed for radiocephalic access creation, from a 2-mm artery and 3-mm cephalic vein 22 to a radial artery diameter >1.65 mm and cephalic vein diameter >1.55 mm.…”

Section: Discussionmentioning

confidence: 99%

“…38 As a result, a wide range of vessel size criteria have been proposed for radiocephalic access creation, from a 2-mm artery and 3-mm cephalic vein 22 to a radial artery diameter >1.65 mm and cephalic vein diameter >1.55 mm. 34 Finally, there is marked heterogeneity in vein diameter reporting among studies. Although a minimum vein diameter in the outflow tract is used in some, 19,21,22,29 a significant number use perianastomotic values, 15,17,20,31,32,36 including four of five randomized controlled trials examining the utility of preoperative duplex ultrasound vs physical examination for access creation.…”

Section: Discussionmentioning

confidence: 99%

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Influence of artery and vein diameters on autogenous arteriovenous access patency

Misskey

Hamidizadeh

Faulds

et al. 2020

Journal of Vascular Surgery

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Objective: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. Methods: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure. Results: A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% 6 3% for radiocephalic accesses and 15% 6 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of artery and vein diameters on autogenous arteriovenous access patency

Misskey

Hamidizadeh

Faulds

et al. 2020

Journal of Vascular Surgery

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“…2) The impact of multiple variables on the FM of RCAVF has been extensively investigated, and to date it has become apparent that certain variables might impact FM. 3) However, conflict regarding their independent impact, association and causal link is persistent, and despite conclusive evidence of a few series, this is negated by others and recent guidelines remain inconclusive. 4) This has been attributed to the fact that the majority of such outcomes are derived from cohort studies, and despite all efforts they could be subjected to selection, performance and conclusion bias or could lack randomisation.…”

Section: Introductionmentioning

confidence: 99%

The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula

Kordzadeh

Esfahlani

2019

Annals of Vascular Diseases

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Objective: The aim of this study is to examine the application of virtual artificial intelligence (AI) in the prediction of functional maturation (FM) and pattern recognition of factors in autogenous radiocephalic arteriovenous fistula (RCAVF) formation.Materials and Methods: A prospective database of 266 individuals over a four-year period with n=10 variables were used to train, validate and test an artificial neural network (ANN). The ANN was constructed to create a predictive model and evaluate the impact of variables on the endpoint of FM.Results: The overall accuracy of the training, validation, testing and all data on each output matrix at detecting FM was 86.4%, 82.5%, 77.5% and 84.5%, respectively. The results corresponded with their area under the curve for each output matrix at best sensitivity and at 1-specificity with the log-rank test p<0.01. ANN classification identified age, artery and vein diameter to influence FM with an accuracy of (>89%). AI has the ability of predicting with a high grade of accuracy FM and recognising patterns that influence it.Conclusion: AI is a replicable tool that could remain up to date and flexible to ongoing deep learning with further data feed ensuring substantial enhancement in its accuracy. AI could serve as a clinical decision-making tool and its application in vascular access requires further evaluation.

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“…According to the National Kidney Foundation, Centre for Medicare and Medicaid Services (CMS) and Dialysis Patient Citizens, arteriovenous fistula (AVF) remains the access of choice (gold standard) for dialysis patients. 1,2) However, an increase in the incidence of end-stage renal disease in association with longer life expectancy has escalated the demand for more reliable, functional, cost effective and durable AVF. 3,4) This has subsequently resulted in the amplification and deployment of different endovascular and open salvage techniques for the management of AVF complications and their longevity.…”

Section: Introductionmentioning

confidence: 99%

Revision Using Distal Inflow for the Treatment of Dialysis Access Steal Syndrome: A Systematic Review

Kordzadeh

Garzon

Parsa

2018

Annals of Vascular Diseases

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The aim of this systematic review is to establish the efficacy of revision using distal inflow (RUDI) on the primary endpoints of complete dialysis access steal syndrome (DASS) resolution and arteriovenous fistula (AVF) longevity. An electronic search of literature from 1966 to 2017 in CINAHL, Medline, Embase and the Cochrane library according to PRISMA standards was conducted. Quality evaluations and recommendations for practice were examined. Data on power, age, gender, comorbidities, arterial inflow, conduit material, fistulae type, follow-up, failure incidence, ischaemia grade, modality of diagnosis, morbidity and mortality were subjected to pooled analysis of prevalence at a 95% confidence interval (CI). Eleven studies involving 130 individuals with a median age of 57 [interquartile ranges (IQR), 54–65] and equal gender distribution were conducted. Of the patients with diabetes mellitus (67.3%), the most common type of AVF with DASS was brachiocephalic AVF (73.7%). Overall, the prevalence of success was 82.0% (95%CI, 74.4%–89.6%) over 12 months (IQR, 1–40 months). Grade 3 ischaemia was the most common type of DASS (49.2%). Grade 4 had the worst outcomes compared with grades 2 and 3. The overall morbidity was 3% with no mortality. Overall, RUDI is an effective treatment for various grades of DASS and their longevity.

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The Impact of Patient Demographics, Anatomy, Comorbidities, and Peri-operative Planning on the Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula

Abstract: Of all the variables, cephalic vein and radial artery diameter are independently associated with the primary functional maturation of RCAVFs.

Cited by 32 publications

References 25 publications

Influence of artery and vein diameters on autogenous arteriovenous access patency

Influence of artery and vein diameters on autogenous arteriovenous access patency

The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula

Revision Using Distal Inflow for the Treatment of Dialysis Access Steal Syndrome: A Systematic Review

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