New hemodynamic variables as predictors of arteriovenous fistula maturation

Abstract

Introduction Failure to mature of native arteriovenous fistula (AVF) assessed by image is not well documented. Methods The aim of this study is to evaluate AVF maturation by Doppler ultrasound within 6 weeks after surgery and check for new hemodynamic variables as prognostic factors. Results A total of 155 native AVFs were created in 3 years. Median age of patients was 71 years (60;79), with male gender predominance of 59.4% (n = 92). Diabetes was present in 60.6% (n = 94). AVF was created in distal forearm in 49.7% (n = 77). Un‐assisted and overall maturation was of 67.1% (n = 104) and 83.9% (n = 130), respectively. Failure to mature occurred in 21.3% (n = 33) and primary failure in 9.7% (n = 15). In univariate analysis, preoperative variables such as diameter of artery (3.5 vs. 2.2 mm; p < 0.001) and pulsatility index (7.9 vs. 6.6; p = 0.055) were associated with failure to mature of AVF. Postoperative variables as Qa (994 vs. 401 mL/min; p < 0.001), resistance index (0.52 vs. 0.63; p < 0.001), pulsatility index (0.74 vs. 1.21; p < 0.001), and acceleration time (0.17 vs. 0.12; p < 0.001) also predicted an unfunctional AVF. Spearman correlation coefficient (r) was good for resistance index (−0.628) and pulsatility index (−0.707) in comparison with blood flow (Qa). In multivariate analysis, postoperative pulsatility index was an independent predictor of AVF dysfunction (OR: 16.5; p < 0.001). Conclusions Failure to mature was of 21.3%. Pulsatility index could be an important tool as new hemodynamic variable to predict failure to mature of native AVF.

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery

“…Brachiocephalic fistulas are more likely to mature than radiocephalic fistulas. 177 But what, exactly, is a properly mature fistula? There is no universal definition.…”