Complications of the Arteriovenous Fistula: A Systematic Review

Abstract

The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes. After screening 2292 citations, 43 articles met our inclusion criteria (61 unique cohorts; >11,374 fistulas). Median complication rates per 1000 patient days were as follows: 0.04 aneurysms (14 unique cohorts; =1827 fistulas), 0.11 infections (16 cohorts;>6439 fistulas), 0.05 steal events (15 cohorts; >2543 fistulas), 0.24 thrombotic events (26 cohorts; =4232 fistulas), and 0.03 venous hypertensive events (1 cohort;=350 fistulas). Risk of bias was high in many studies and event rates were variable, thus we could not present pooled results. Studies generally did not report variables associated with fistula complications, patient comorbidities, vessel characteristics, surgeon experience, or nursing cannulation skill. Overall, we found marked variability in complication rates, partly due to poor quality studies, significant heterogeneity of study populations, and inconsistent definitions. There is an urgent need to standardize reporting of methods and definitions of vascular access complications in future clinical studies to better inform patient and provider decision making.

Lipoprotein apheresis efficacy, challenges and outcomes: A descriptive analysis from the UK Lipoprotein Apheresis Registry, 1989–2017

“…However, the high flow rates needed for haemodialysis that they provide are not needed for LA and AV fistulas can give rise to problems such as strictures at the anastomosis [23]. Infection, aneurysm, vascular steal and thrombosis are well-described in the context of AV fistulas used for haemodialysis [24].…”

Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients

“…[ 3 ] Thrombosis and stenosis are closed related with AVF, and they will increase patients’ economic burden and lower their quality of life, which are the main causes for AVF failure. [ 9 ] In a prospective 2-year longitudinal study, 237 (32.3%) of 734 patients had AVF stenosis or thrombosis, leading to AVF failure. [ 10 ]…”

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

“…HD-related steal seems to occur more frequently with brachial AVF than with radial or ulnar fistulas. In a systematic review of the Medline literature (from 2000 to 2014, including 43 English-written reports of prospective trials), Al-Jaishi et al [34] concluded that the median complication rate of steal events per 1000 patient days was 0.05. The authors acknowledged that the risk of bias was high and event rates were highly variable, partly due to poor quality studies, significant heterogeneity of study populations and inconsistent definitions of ‘steal syndrome’.…”