Factors affecting the patency of arteriovenous fistulas for dialysis access

Smith, George E.; Gohil, Risha; Chetter, Ian

doi:10.1016/j.jvs.2011.07.095

Cited by 223 publications

(201 citation statements)

References 49 publications

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“…In patients with stenosis, the median value of the minimum diameter of the stenotic area was 2.4 mm (1.7-2.7 mm). For juxtaanastomotic localisation of steno- [21,[25][26][27]. The small calibre of these vessels was associated with the presence of stenosis also in our study.…”

Section: Resultssupporting

confidence: 80%

Ultrasonographic diagnosis of stenosis of native arteriovenous fistulas in haemodialysis patients

et al. 2016

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Aims: Ultrasound (US) examination is an important tool in the diagnosis of arteriovenous (AVF) stenoses; different US measures are available for assessing the severity of stenoses. The aim of our study was to analyse risk factors and consequences of AVF stenosis and its severity and to compare the usefulness of different US measures of stenoses' severity. Material and methods: Ninety-seven prevalent patients from a single dialysis centre with patent AVF were included. We recorded history of disease, clinical and laboratory data. US was used to diagnosis the stenosis and to measure blood flow in the brachial artery, resistivity index (RI), and the diameter of the vessels (arteries, anastomosis, venous outflow). Results: Stenosis was present in 54.64% of the patients (59.6% juxtaanastomotic). Stenosis patients had higher age, lower diameter of the brachial artery, lower anastomosis diameter, and lower diastolic blood pressure (DBP). Atherosclerosis, delayed maturation of AVF, and statin treatment were more prominent in the stenosis group. Logistic regression disclosed delayed maturation, cholesterol, atherosclerosis, and DBP as significant predictors of stenosis. When severe stenosis was measured by the diameter reduction, stenosis patients had higher age, lower HDL cholesterol, and poorer dialysis efficacy. Flow in the brachial artery and RI were less useful for identifying risk factors or differences in outcome. Conclusions: Prevalence of stenosis was high in our cohort, more than half of the patients having some degree of stenosis. Risk factors for stenosis were related to atherosclerosis, low DBP, and delayed maturation of AVF. Diameter of stenosis is the most useful marker of severity.

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Section: Resultssupporting

confidence: 80%

Ultrasonographic diagnosis of stenosis of native arteriovenous fistulas in haemodialysis patients

et al. 2016

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“…With regard to AVF placement, the associations with participant factors, such as age, sex, race, obesity, diabetes, and coronary or peripheral artery disease, have been extensively evaluated previously (8,(24)(25)(26)(27)(28). In the present cohort, placement of upper-arm AVFs was more common in women, older patients, and those with coronary artery disease and diabetes.…”

Section: Discussionmentioning

confidence: 78%

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Robbin¹,

Greene²,

Cheung³

et al. 2016

Radiology

111

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“…A physical examination should document blood pressure differences between the upper extremities [51] and an Allen test should be performed as the lack of a well-developed palmar arch predispose for vascular steal symptoms in case the dominant artery is used for the VA creation [52] . Smith et al [53] suggest that patient factors, such as increasing age, presence of diabetes, smoking, peripheral vascular disease, predialysis hypotension and vessel characteristics, directly influence AVF patency. Vessels of small caliber (< 2 mm) or demonstrating reduced distensibility are unlikely to create a functional AVF.…”

Section: Permanent Vamentioning

confidence: 99%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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Factors affecting the patency of arteriovenous fistulas for dialysis access

Abstract: There is a complex interaction of factors that may affect the patency of an individual AVF. These need to be carefully considered when selecting surgical site or technique, adjuvant treatments, and follow-up protocols for AVFs.

Cited by 223 publications

References 49 publications

Ultrasonographic diagnosis of stenosis of native arteriovenous fistulas in haemodialysis patients

Ultrasonographic diagnosis of stenosis of native arteriovenous fistulas in haemodialysis patients

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Vascular access today

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