Independent association of arteriovenous ratio index on the primary functional maturation of autologous radiocephalic arteriovenous fistula

Kordzadeh, Ali; Askari, Alan; Panayiotopoulos, Y.P.

doi:10.1016/j.jvs.2017.10.082

Cited by 6 publications

(11 citation statements)

References 31 publications

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“…Although a minimum vein diameter in the outflow tract is used in some, 19,21,22,29 a significant number use perianastomotic values, 15,17,20,31,32,36 including four of five randomized controlled trials examining the utility of preoperative duplex ultrasound vs physical examination for access creation. 12 Others have used mean outflow measurements 39 or do not specify how or what diameters were used (table ambiguity is evidenced in the most recent European vascular access guidelines, which recommend avoidance of radiocephalic accesses when the cephalic vein is <2 mm but do not specify what this diameter represents (perianastomotic, minimum vein diameter, mean diameter) or whether adjuncts such as tourniquets should be used for this measurement. 24 The decision regarding the optimal access is multifaceted and requires consideration of both patient and clinical factors.…”

Section: Discussionmentioning

confidence: 99%

Influence of artery and vein diameters on autogenous arteriovenous access patency

Misskey

Hamidizadeh

Faulds

et al. 2020

Journal of Vascular Surgery

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Objective: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. Methods: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure. Results: A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% 6 3% for radiocephalic accesses and 15% 6 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [

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Section: Discussionmentioning

confidence: 99%

Influence of artery and vein diameters on autogenous arteriovenous access patency

Misskey

Hamidizadeh

Faulds

et al. 2020

Journal of Vascular Surgery

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“…It is possible that the outline of a 3D shape changes without moving the centerline. We chose a centerline-based approach because it has been extensively used in the AVF and non-AVF settings in the literature [3][4][5][6][7][8][9][10][11][12][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…However, a clinical study [11] and a simulation-based study that used patient-derived geometries [18] found that a larger angle is better for AVF development. Yet, a few clinical studies found that the angle did not affect maturation [12], or stenosis [9,10]. To the best of our knowledge, there is no literature on the tortuosity or nonplanarity angle of the human AVF vein.…”

Section: Discussionmentioning

confidence: 99%

“…Hemodynamics are, in turn, influenced by vessel lumen geometry [3][4][5][6], indicating the potential importance of vessel lumen geometry on AVF remodeling. Several clinical studies have investigated the effect of geometry on AVF development by association [7][8][9][10][11][12]; some have found that geometry could influence AVF patency [8] and maturation [7]. The geometry in these previous studies was simplified [3][4][5][6] or manually measured in the operating room [8][9].…”

Section: Introductionmentioning

confidence: 99%

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The Geometry of Arteriovenous Fistulas Using Endothelial Nitric Oxide Synthase Mouse Models

et al. 2020

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BackgroundArteriovenous fistula (AVF) maturation failure is a significant clinical problem in the hemodialysis population. Geometric parameters of human AVFs were associated with AVF development, but causative studies are lacking. We characterized mouse AVF geometry using endothelial nitric oxide synthase (NOS3) mouse models.MethodsCarotid-jugular AVFs were created in NOS3 overexpression (OE), knockout (KO), and wild-type (WT) mice. At 7 and 21 days postcreation, black-blood magnetic resonance images of AVFs were acquired and used to build three-dimensional reconstructions of AVF lumens. We used these reconstructions to calculate the lumen area, lumen centerline, and centerline-derived parameters: anastomosis angle, tortuosity, nonplanarity angle, and location of maximal distance between the feeding artery and AVF vein. Inter- and intrauser variabilities were also determined.ResultsWhen all mice were considered, increased minimum AVF venous lumen area was accompanied by increased venous tortuosity and increased distance between the artery and vein, with both remaining in plane with the anastomosis. At day 7, the lumen area of AVFs from all strains was 1.5- to 2.5-fold larger than native veins. Furthermore, at day 21, AVF lumen in NOS3 OE (4.04±1.43 mm2) was significantly larger than KO (2.74±1.34 mm2) (P<0.001) and WT (2.94±1.30 mm2) mice (P<0.001). At day 21, the location of maximal artery-vein distance on the vein was further away from the anastomosis in OE (4.49±0.66 mm) than KO (2.87±0.38 mm) (P=0.01). Other geometric parameters were not significantly different between mouse strains or time points. Inter- and intrauser variabilities were small, indicating the reliability and reproducibility of our protocol.ConclusionsOur study presents a detailed characterization of mouse AVF geometry, and a robust protocol for future mechanistic studies to investigate the role of molecular pathways in AVF geometry. Identifying a geometry related to desired AVF remodeling can help inform surgery to enhance AVF maturation.

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“…Our study showed that preoperative diameter size of the blood vessels with achieved adequate BF was significantly larger compared to the diameter size of the blood vessels without achievement of adequate BF, at the fourth week of AVF creation. The multivariate binary logistic regression analysis, in the study of Kordzadeh et al, demonstrated that diameter of the cephalic vein >1.55 mm (OR 4.57, 95% CI 2.42‐8.63, P < .001), and diameter of the radial artery ≥1.65 mm (OR 12.26, 95% CI 6.27‐23.97, P < .001) were independently associated with successful maturation of the AVF 16 . In our study the diameter of the radial artery before creation of AVF larger than 2.0 mm was significantly associated with higher BF at the fourth week of creation compared to the diameter of the radial artery smaller than 2.0 mm (629.22 mL/min vs 319.07 mL/min, P = .000).…”

Section: Discussionmentioning

confidence: 99%

Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis

et al. 2020

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An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P = 0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation.

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Independent association of arteriovenous ratio index on the primary functional maturation of autologous radiocephalic arteriovenous fistula

Cited by 6 publications

References 31 publications

Influence of artery and vein diameters on autogenous arteriovenous access patency

Influence of artery and vein diameters on autogenous arteriovenous access patency

The Geometry of Arteriovenous Fistulas Using Endothelial Nitric Oxide Synthase Mouse Models

Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis

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