Determinants of successful arteriovenous fistulae creation including intraoperative transit time flow measurement

Abstract

Background: The prevalence of hemodialysis patients is increasing, and it is important to create the arteriovenous fistula as early as possible to avoid hemodialysis by central venous catheter. International guidelines recommend arteriovenous fistula as the vascular access of first choice. Arteriovenous fistulae are associated with a failure rate of 23%. The success of an arteriovenous fistula can be evaluated intraoperatively by physical examination and by measuring the blood flow. Objectives: The aim of the study is to describe the predictive value of various factors for fistula maturation in the context to the current literature. Methods: We report on a prospective cohort study of 41 patients, undergoing a primary arteriovenous fistula at the upper extremity. The primary endpoint of the study was the successful fistula maturation after 6 weeks. Results: The intraoperative measurement of the blood flow in the outflow vein has been identified as the unique significant parameter for the fistula maturation. Conclusion: The predictive value of intraoperative flow measurement is superior to intraoperative physical examination and could help reduce the fistula dysmaturation rate. Intraoperative transit time flow measurement is an easy method and can be used to predict successful fistula maturation in a high percentage rate.

The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis

“…25,27 Multiple risk factors affect AVF maturation, including gender, age, target vein size, target arterial size, diabetes, peripheral arterial disease, [28][29][30] and surgeons' characteristics and experience. 31 Careful site selection, 32 pre-operative ultrasound assessment of vessels, [33][34][35] intra-operative flow measurement, 36 ultrasound-guided cannulation in early matured SCVA, 37,38 and SCVA maturation tracking system 39 are some of the ways to enhance SCVA usage and shorten CVC-dependent time and reduce healthcare expenditure. Appropriate use of AVG in patients with unfavorable venous asset might also minimize the percentage of failure-to-mature AVFs.…”

“…[40][41][42] Effective training of access surgeons on clinical decision-making and skill should be a focus of the specialty. 36,43 More effort should be injected into the healthcare system to monitor and enhance a high SCVA success rate.…”

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

“…Intraoperative TTF is commonly used in coronary artery bypass surgery to assess graft flow and has been found to show significant correlations with graft patency in both short-term and mid-term evaluations [8]. However, few studies have applied intraoperative TTF to analyze AVF creation [9]. Our study found that TTF was a predictor of RCAVF maturation (p<0.001) and identified a TTF of ≥105 mL/min as the most suitable cutoff value (AUC, 0.71).…”