The Pros and Cons of Preserving a Functioning Arteriovenous Fistula after Kidney Transplantation

Voorzaat, Bram M.; Schaik, Jan van; Siebelink, Hans‐Marc J.; Tordoir, Jan H.M.; Rotmans, Joris I.

doi:10.5301/jva.5000525

Cited by 25 publications

(24 citation statements)

References 41 publications

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“…The effective CO, defined as the CO minus the AVF Qa, steadily decreases, resulting in systemic hypoperfusion. This state of pseudo‐normalization is often overlooked, as the CO appears normal if the AVF Qa is not subtracted from it . A change to CVC access is a consideration in this setting.…”

Section: The Impact Of An Arteriovenous Access On Hemodynamic and Cirmentioning

confidence: 99%

The complex relationship among arteriovenous access, heart, and circulation

Basile

Lomonte

2017

Seminars in Dialysis

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There are currently near 400 000 patients on hemodialysis in the United States. More than 50% of those treated by chronic hemodialysis die because of a cardiovascular (CV) event. The majority of these patients have functional arteriovenous fistulas (AVFs).AVFs have an adverse effect on cardiac function, but their exact contribution to CV morbidity is not clear. It has long been known that a vascular access with an inappropriately high-flow rate may cause high-output heart failure. Paradoxically, there may be hemodynamic and cardiopulmonary benefits conferred by AVF particularly in severe chronic obstructive pulmonary disease. While Brescia-Cimino`s basic idea of the AVF has saved millions of lives, we would like to stress that there are dangers from their often high blood flow rates, which unfortunately have proved difficult to evaluate.

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Section: The Impact Of An Arteriovenous Access On Hemodynamic and Cirmentioning

confidence: 99%

The complex relationship among arteriovenous access, heart, and circulation

Basile

Lomonte

2017

Seminars in Dialysis

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“…In addition, RCAVFs are associated with a lower incidence of HD access-induced distal ischemia [ 3 ], when compared to upper arm AVFs. High flow also predisposes to increased cardiac output and impaired systemic blood flow in patients with impaired cardiac function, a phenomenon known as ‘AVF cardiotoxicity’ [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Arteriovenous Fistula Maturation Failure in a Large Cohort of Hemodialysis Patients in the Netherlands

et al. 2017

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Objectives Radiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs. Furthermore, the efficacy of interventions to promote maturation as well as the variability between hemodialysis centers was evaluated. Materials Medical records from 8 hospitals from 1997 to 2016 were retrospectively evaluated for VA type, maturation/ primary success and demographics and comorbidities. Methods A prediction model was created for RCAVF nonmaturation using multivariate logistic regression analysis, selecting significant predictors using backward selection. Discrimination and calibration of the model were assessed. Results 1383 AVFs and 273 AVGs were included in 1221 patients. Overall nonmaturation was 24% for RCAVFs, and 11% for upper arm AVFs. The functional failure rate for AVGs was 6%. The nonmaturation rate of contralateral RCAVFs after failure of an RCAVF was 22%. Procedures to improve RCAVF maturation were successful in 98/142 cases (69%). Predictors for nonmaturation were female gender, peripheral vascular disease, cerebrovascular disease and a cephalic vein diameter \2.5 mm, but the prediction model lacked sensitivity and specificity predicting individual RCAVF nonmaturation (C-statistic 0.629). Conclusion Nonmaturation rates are highest for RCAVFs, but nonmaturation could not be predicted with demographic parameters.

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“…Maintenance of a nonfunctioning AVF in a transplant patient is not always necessary nor advisable, given potential consequences of increased cardiac output and pulmonary artery pressure. 15 Vascular surgery specialists may recommend temporary or permanent intraoperative ligation should the need arise from bleeding or a positive deep margin, the latter of which was the case for patient 2. Complete histologic clearance should be achieved.…”

Section: Discussionmentioning

confidence: 99%