Predicting Arteriovenous Fistula Maturation with Intraoperative Blood Flow Measurements

Berman, Scott S.; Mendoza, Bernardo; Westerband, Alex; Quick, Rhonda C.

doi:10.1177/112972980800900404

Cited by 41 publications

(21 citation statements)

References 14 publications

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“…Several strategies to increase the AVF maturation rate have been proposed. These include preoperative and intraoperative examinations to identify fistulas at risk of maturation failure and aggressive postoperative interventions to salvage nonmaturing fistulas (5)(6)(7)(8). Nonetheless, less attention has been paid to the early postoperative period.…”

Section: Introductionmentioning

confidence: 99%

A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

Han¹,

Min²,

Kim

et al. 2016

CJASN

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Section: Introductionmentioning

confidence: 99%

A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

Han¹,

Min²,

Kim

et al. 2016

CJASN

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“…Another report by Won et al [14] found that a radiocephalic AVF flow less than 160 mL/min was associated with a high early failure rate, and intraoperative low flow was determined to be an independent risk factor. A report by Berman et al [15] was the first study to establish the minimal flow rates needed for maturation and subsequent patency of brachiocephalic AVF. According to the report of Berman et al [15], a cutoff of 308 mL/min was needed for Glomerulonephritis, unknown kidney disease, and polycystic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis

Lee

Chang

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis. Methods: We retrospectively reviewed the medical records of 41 patients who underwent surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography. Results: The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to maintain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (subjects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were additionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional brachiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007). Conclusion: Transit-time flow, as measured with intraoperative transit-time ultrasonography, was associated with patency without the need for intervention at 1 year after initiation of hemodialysis.

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“…[21] observed during the 12-month period in 70 autologous AVFs intraoperative blood flow measurements at the time of autologous AVF construction can identify fistulas that are unlikely to mature; and therefore, that require immediate revision or abandonment which will ultimately expedite the establishment of a useful access in the HD patient.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis

et al. 2017

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Background:Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high “failure to mature” (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM.Materials and Methods:This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated.Results:Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively).Conclusion:Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4–6 weeks after surgery should be considered mandatory.

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Predicting Arteriovenous Fistula Maturation with Intraoperative Blood Flow Measurements

Cited by 41 publications

References 14 publications

A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis

Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis

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