Impact of Previous Tunneled Vascular Catheters and their Location on Upper Limb Arteriovenous Fistula Function

Abstract

Background: Long-term Arteriovenous Fistula (AVF) survival has been shown to be adversely impacted by the presence of previous Tunnelled Vascular Catheters (TVC). We analysed the effect of previous TVCs and their location (ipsilateral versus contralateral) on the successful function of upper limb AVFs in the first 12-months after creation. Methods: We retrospectively reviewed clinical data on patient's first upper limb AVFs, created between January 2013 and December 2017. We analysed the rates of successful AVF function (successful cannulation using 2 needles for ≥50% sessions over a 2-week period) at 6- and 12- months post creation, time to AVF maturation, and rates of assisted maturation. Results: 287 patients with first AVFs were identified, of which 142 patients had a previous TVC (102 contralateral, 40 ipsilateral) and 145 had no previous TVC. The No TVC group had higher rate of AVF function at both 6-months (68.6% vs 54.3%, OR 1.84, 95% CI 1.00-3.39, p=0.05) and 12-months (84.3% vs 63.5%, OR 3.10, 95% CI 1.53-6.26, p=0.002) compared to the TVC group. The Contralateral TVC group had higher rate of AVF function at 6-months (59.6% vs 40%, OR 2.21, 95% CI 1.01-4.88, p=0.05), but not at 12-months (65.9% vs 57.6%, OR 1.42, 95% CI 0.62-3.25, p=0.40) compared to the Ipsilateral TVC group. The median time to AVF maturation in the Contralateral and Ipsilateral TVC groups were 121.5 and 146 days respectively (p=0.07). Assisted maturation rates were lower in No TVC group compared to the TVC group (12.4% vs 27.9%, p=0.007), but similar between the Contralateral and Ipsilateral TVC groups (28.7% vs 25.7 %, p= 0.74). Conclusions: Previous TVC use was associated with poorer AVF function at 6- and 12-months, with a higher rate of assisted maturation. The presence of an ipsilateral TVC was associated with lower successful AVF use at 6-months, compared to contralateral TVC.

The Sisyphean Task of Getting the Arteriovenous Fistula to Mature

“…In this issue, Diep et al report their single-center retrospective analysis to determine the effects of TVC laterality on an upper-limb AVF functionality at 6 and 12 months (9). As expected, the No TVC group had higher AVF function compared with TVC at both time points.…”