Failure of arteriovenous fistula maturation: an unintended consequence of exceeding Dialysis Outcome Quality Initiative guidelines for hemodialysis access

Patel, Sheela T.; Hughes, John D.; Mills, Joseph L.

doi:10.1016/s0741-5214(03)00732-8

Cited by 246 publications

(173 citation statements)

References 24 publications

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“…However, we strongly believe that endovascular treatment should be attempted before surgery is considered for the following reasons: (1) We and others (22)(23)(24)33) have demonstrated that endovascular treatment is associated with excellent success rates, low complication rates, and promising long-term patency rates (24). Most important, this is done without the introduction and assistance of synthetic polytetrafluroethylene grafts.…”

Section: Discussionmentioning

confidence: 99%

“…The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21)(22)(23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.…”

mentioning

confidence: 99%

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Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

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In recent literature, surgically created hemodialysis (HD) arteriovenous fistulas (AVF) have high rates of primary failure. Endovascular treatment holds promise to salvage these fistulae. The outcomes of 119 patients who had a "failing to mature" AVF and presented for endovascular management were evaluated prospectively. All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).Overall, an increase in AVF prevalence is occurring in the United States, albeit at a slow rate (14 -20). One impediment has been high primary failure rates, which in recent series ranged between 23 and 46% (9,(12)(13)(14). The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21-23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.In our dedicated endovascular suite, we used percutaneous angioplasty and accessory vein obliteration in attempts to salvage fistulas with primary failure. Because most did not present with thrombosis, we elected to refer to their fistulas as "failing to mature." In this article, we report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their "failing to mature" AVF. Materials and Methods DefinitionsThe "failing to mature" AVF in our series was defined as an AVF that had been created for at least 8 wk but had not matured enough to allow successful cannulation or use during HD. This includes (1) fistulas that were never cannulated for HD be cause of obvious lack of maturity; (2) fistulas that failed first cannulation attempts and were abandoned; (3) fistulas that were cannulated successfully but could not be used because the blood flow was insufficient to sustain HD; this may have been because of high venous pressure or poor arterial inflow; and (4) fistulas that thrombosed before any attempts at HD. Juxta-arterial anastomosis segment refers to the initial 5 cm of the AVF starting at the arterial anastomosis. Peripheral vein refers to the venous outflow tract of t...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

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“…Studies conflict regarding the association between women, AVF nonmaturation, and reduced patency (6)(7)(8)(9), which is hypothesized to be related to smaller diameter veins in women compared with men. This is difficult to assess, because many studies do not perform preoperative vein mapping or report vein diameters.…”

Section: Demographicsmentioning

confidence: 99%

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Woo

2016

CJASN

101

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Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care. In this review, we will discuss the key determinants in optimal access type and timing of access creation for upper extremity arteriovenous fistulas and grafts.

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“…Many variables should be considered (89,92,93), and using minimal vessel diameter as a sole criterion should be avoided. Doing so may preclude the use of veins that would have been acceptable by clinical examination (24,94). Furthermore, several recent studies demonstrated no significant association between vessel diameter and AVF primary failure (95).…”

Section: Continue Fistula First With Review and Reevaluation Of The 1mentioning

confidence: 99%