Maturation of arteriovenous fistula: Analysis of key factors

Abstract

The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.

Association Between Arteriovenous Fistulae and Hematomas in a Dialysis Center in the State of Rio Grande Do Sul, Southern Brazil

“…According to the literature, variables such as age, educational level, diabetes, peripheral vascular disease, hypertension, coagulopathy, obesity, and smoking affect AVF maturation time and hematoma formation 7,8,[11][12][13][14] . Consistent with our results, Lee et al (2006) 11 prospectively studied AVF infiltration in the United States and found no association of sex, race, and diabetes with occurrence of hematomas.…”

“…In patients with CKD, conventional hemodialysis can be performed through different types of vascular access, including central venous catheter and arteriovenous fistula (AVF) 7 . An AVF consists of a subcutaneous anastomosis between an artery and an adjacent vein, with dilation of superficial veins, allowing constant circulation and repeated needle insertion 8,9 .…”

“…Hematomas may present with several forms according to a patient's hemostatic state as well as blood volume and time of blood confinement at the cannulation site 7,8 . Period of cannulation, use of anticoagulation, and dose and type of anticoagulant are factors which contribute to hematoma formation 8,9 . Thus, an adequate cannulation technique is essential for preventing AVF hematomas.…”

“…Hematomas are a major complication because they impair the process of cannulation and, therefore, dialysis, affecting directly the quality of life of a patient with kidney disease. In addition, hematomas contribute to complications such as AVF thrombosis and stenosis 8,9 .…”

Korelasi Blood Flow Rate Intraoperasi dan Enam Minggu Pascaoperasi Arteriovenous Fistula Brakiosefalika Dihubungkan dengan Maturitas di RSUP Prof. Dr. R. D. Kandou Manado

“…Hal ini berbeda dengan acuan pustaka lainnya yang menyatakan bahwa faktor risiko seperti penyakit kardiovaskular, hiperlipidemia, dan hipertensi dapat menurunkan kemungkinan menjadi maturnya suatu AVF, dengan asumsi terjadinya disfungsi endotel pada penyandang hipertensi. 12 Hiperurisemia merupakan salah satu komorbid yang diamati pada penelitian ini mengingat cukup tinggi jumlah pasien PGK dengan komorbid ini Hal ini sesuai dengan acuan pustaka yang menyatakan bahwa hiperurisemia mempunyai hubungan erat dangan angka kejadian PGK tahap akhir. 13 Pada penelitian ini didapatkan 25 pasien (61%) yang menyandang hiperurisemia, dan terdapat 23 pasien dengan AVF yang menjadi matur, dan hanya 2 pasien dengan AVF yang tidak matur.…”