The natural history of vascular access for hemodialysis: A single center study of 2,422 patients

Papanikolaou, Vasilios; Papagiannis, A.; Vrochides, Dionisios; Ιmvrios, G.; Gakis, D.; Fouzas, I.; Antoniadis, Nikolaos; Takoudas, D

doi:10.1016/j.surg.2008.11.003

Cited by 25 publications

(18 citation statements)

References 43 publications

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“…26 Furthermore, in a study with 2422 patients, it was demonstrated that if the BVT AVF only is performed as a third choice for vascular access it has superior primary patency rates compared to that of a BC AVF. 27 In our series, more females were present in the BVT AVF group compared to BC AVF. Stoikes et al described a series in which superficialisation of the efferent vein was performed more often in obese patients compared to non-obese patients.…”

Section: Discussionmentioning

confidence: 47%

The Basilic Vein and the Cephalic Vein Perform Equally in Upper Arm Arteriovenous Fistulae

Ayez

Houten

Smet

et al. 2012

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 47%

The Basilic Vein and the Cephalic Vein Perform Equally in Upper Arm Arteriovenous Fistulae

Ayez

Houten

Smet

et al. 2012

European Journal of Vascular and Endovascular Surgery

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“…AVG have been noted consistently to have inferior primary and secondary patency rates 17,20 ; accordingly, recent reports, 21,22 including one with a median follow-up of 6 years, 21 have suggested that BB should be used in preference to AVG. Furthermore, Choi et al 19 reviewed their institution’s experience comparing transposed fistulae (consisting of autogenous forearm and basilic) versus AVG and direct fistulae, concluding that the transposed had improved long-term patency significantly at 2 years.…”

Section: Discussionmentioning

confidence: 98%

Two-stage brachial-basilic transposition fistula provides superior patency rates for dialysis access in a safety-net population

González

Kashuk

Moore

et al. 2010

Surgery

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Background Guidelines of the National Kidney Foundation recommending aggressive pursuit of autogenous fistulae for dialysis access in lieu of prosthetic arteriovenous grafts have stimulated a renewed interest in transposed brachial-basilic fistulae as an alternative technique for upper arm access in patients who may not be candidates for a lower arm radial-cephalic or forearm brachial-cephalic fistula. We hypothesized that in our safety-net population, where radial-cephalic and brachial-cephalic often are not possible, brachial-basilic would provide patency rates superior to arteriovenous grafts and equivalent to radial-cephalic and brachial-cephalic fistulae. Methods We analyzed retrospectively our most recent 2.5-year experience with dialysis access procedures at our metropolitan safety-net hospital. Procedures were grouped as follows: radial-cephalic, brachial-cephalic, brachial-basilic, and arteriovenous grafts. The access outcomes measured were primary failure, time to use, need for intervention, and primary as well as secondary patency. Differences in age, sex, race, renal function (Modification of Diet in Renal Disease), baseline diagnoses (diabetes mellitus, hypertension, coronary artery disease, and peripheral vascular disease), as well as the number of previous accesses, were adjusted in the analysis. Logistic regression was used to identify independent predictors of primary failure, and Kaplan-Meier plots assessed differences in primary patency rates. A log of the time variables was used to approximate normal distribution. Results In all, 193 patients were included in this study as follows: radial-cephalic, 75 (39%) patients; brachial-cephalic, 35 (18%) patients; brachial-basilic, 33 (17%) patients; and arteriovenous grafts, 50 (26%) patients. Primary patency means differed marginally between groups (P = .08), and when grafts were excluded from the analysis, no difference was found between primary patency in all autogenous fistula techniques (P = .88). Kaplan-Meier plots showed that when analyzing the first 35 weeks, a significantly lower primary patency among graft recipients early after the procedure was noted, and a higher performance of BB after 20 weeks was noted (log-rank P = .05,Wilcoxon P = .004). Furthermore, secondary patency did not vary significantly between groups (P = .62). Radial-cephalic were more likely to fail primarily when compared with the other access groups (P = .03), and in a univariate analysis, underlying hypertension was associated with a lower risk of primary failure (P = .01) compared with other diagnoses. A logistic regression stepwise selection showed that the underlying diagnoses of peripheral vascular disease, diabetes mellitus, or coronary artery disease were associated with a greater risk of primary failure compared with those with HTN (P = .001; odds ratio, 4.05; 95%confidence interval, 1.71–9.59), as well as the presence of a previously failed access (P = .04; odds ratio, 2.39; 95% confidence interval, 1.08–5.67). Conclusion In a safety-net population, our r...

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“…These serial data could be more representative of VA patency than a single measurement of VABF. In addition, according to the natural history of VA, the VA patency rates rapidly decrease during the early period, and loss of VA patency occurs at a rate of 25% within 9 months (14). Moist et al (15) reported that a longer time between graft creation and study enrollment is associated with a decreased risk of graft thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

et al. 2010

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The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.

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The natural history of vascular access for hemodialysis: A single center study of 2,422 patients

Cited by 25 publications

References 43 publications

The Basilic Vein and the Cephalic Vein Perform Equally in Upper Arm Arteriovenous Fistulae

The Basilic Vein and the Cephalic Vein Perform Equally in Upper Arm Arteriovenous Fistulae

Two-stage brachial-basilic transposition fistula provides superior patency rates for dialysis access in a safety-net population

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

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