Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives

Abstract

Autogenous radial-cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.

Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy

“…In general, AVF represents the best vascular access in HD and should be the first choice according to different guidelines [ 20 , 37 , 38 ], due to a better function with lower complications and mortality. It is well known that determining the optimal vascular access is based on a multitude of factors such as age, gender, comorbidities, life expectancy, patient anatomy, surgeon experience and organizing capacities of the single HD center [ 39 , 40 ]. The concerns about smaller vessels in women, leading to poorer AVF maturation and less long-term patency, may have prevented nephrologists and surgeons from considering AVF in female HD patients.…”

“…The concerns about smaller vessels in women, leading to poorer AVF maturation and less long-term patency, may have prevented nephrologists and surgeons from considering AVF in female HD patients. Several studies have showed no differences in vasculature of females in HD by duplex ultrasound examination, with consequent adequacy of AVF placing [ 21 , 40 ]. Even if it seems that vein and arterial anatomy and caliber do not differ significantly by gender, some authors have hypothesized that the worst AVF outcome reported in women in some studies [ 21 , 41 ], but not in others [ 42 ], may persuade surgeons and nephrologists to prefer CVC.…”

“…Finally, it is possible that aesthetic preferences may lead to the use of CVC in women. Some other possible explanations related to CVC preference in women might be related to cosmetic reasons as well as to low surgical training and experience [ 40 ]. It remains that the reduction of gender disparity in the access to AVF in patients initiating HD requires further investigation in the next future.…”

Heterogeneous Maturation of Arterio-Venous Fistulas and Loop-Shaped Venous Interposition Grafts: A Histological and 3D Flow Simulation Comparison

“…Concerning the commonly used artificial arterio-venous fistulas and the rarely applicable loop-shaped grafts (arterial or venous interposition), failure is still a challenging problem [ 2 , 7 , 8 ]. Arterio-venous interposition grafts can be used in clinical reconstructive microsurgery when proper vessels are not available or long enough in free flap operations [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Frequency of Dysfunctional Arteriovenous Fistula among End Stage Renal Disease Patients on Thrice Weekly Maintenance Hemodialysis

“…7 Physical examination (PE) has a reasonable efficacy for identifying complications in fistulas. Physical assessment is handily educated, effortlessly performed, ---------------------------------------------------------------------------------------Received on 21-08-2021 Accepted on 11-01-2022 immediately done, and cost-effective 8 . Doppler ultrasound is a straightforward, economical, and harmless strategy for the evaluation of blood flow in AVF.…”