First-week Postoperative Flow Measurements are Highly Predictive of Primary Patency of Radiocephalic Arteriovenous Fistulas

Ladenheim, Eric D.; Lulic, Dzenan; Lum, Craig; Agrawal, Siddhartha; Chadwick, Nathan

doi:10.5301/jva.5000544

Cited by 21 publications

(18 citation statements)

References 16 publications

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“…Postoperative ultrasound measurements have been used to predict AVF clinical maturation in several small, single-center series, 10,11,[13][14][15][16][17][18][19][20][21] using brachial or radial artery, or AVF vein inner diameter measurements, and blood flow measured in varying locations of these arteries or the AVF vein, limiting comparability. Early AVF clinical maturation criteria, proposed by a 2002 University of Alabama study, focused on AVF blood flow and diameter.…”

mentioning

confidence: 99%

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Robbin¹,

Greene²,

Allon

et al. 2018

JASN

142

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Background The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, although maturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

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mentioning

confidence: 99%

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Robbin¹,

Greene²,

Allon

et al. 2018

JASN

142

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“…We did not see any significant change in the flows from the intraoperative to the first postoperative week of either the HeRO device or the SFA-tFV fistula. In this regard both these accesses behave differently from the radiocephalic fistula whose flow increases in the first week postoperatively (16).…”

Section: Discussionmentioning

confidence: 99%

Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft

Ladenheim¹,

Lulic²,

Lum³

et al. 2017

J Vasc Access

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“…While previous studies have used POCUS to monitor BFRs, vessel diameter, resistance indices, and distensibility, none assessed likelihood for cannulation. 17,[25][26][27][28][29][30][31][32][33] Finally, POCUS can also be utilized in diagnosing access complications, and has been shown to be a more accurate way of assessing volume status in HD patients. 49,50 The limitations of our study include a retrospective control, a single site, a younger population, and few Caucasians.…”

Section: As Per National Kidney Foundation Kidney Diseasementioning

confidence: 99%

“…In recent years, several single-center studies have been published investigating the use of POCUS to assess for AVF maturation by assessing BFRs, arterial and venous diameters, resistance indices, and vessel distensibility. 17,[25][26][27][28][29][30][31][32][33] At our center, POCUS has been used to enable earlier cannulation and identification of potential problems. 34 This study evaluates the use of POCUS measurements of fistula diameter, depth, and length as an indicator for earlier cannulation and identification of complications.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

et al. 2020

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Background: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. Methods: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. Results: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. Conclusion: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.

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First-week Postoperative Flow Measurements are Highly Predictive of Primary Patency of Radiocephalic Arteriovenous Fistulas

Cited by 21 publications

References 16 publications

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

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