Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula

Shimizu, Yuki; Nakata, Jun; Maiguma, Masayuki; Shirotani, Yuka; Fukuzaki, Haruna; Nohara, Nao; Io, Hiroaki; Suzuki, Yusuke

doi:10.1016/j.ekir.2020.07.030

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…There is a general trend toward a substantially increased number of patients receiving maintenance dialysis worldwide [1]. Vascular access is vitally important in maintenance hemodialysis (HD) because vascular access-related complications are one of the major causes of hospitalization for dialysis patients [2]. Vascular access requires adequate blood flow, long-term patency, and ease of cannulation.…”

Section: Introductionmentioning

confidence: 99%

“…The resistance index (RI) of the brachial artery is a common parameter in the US evaluation of AVFs. The RI after AVF creation can predict primary patency and help plan intervention [2,10]. Although several reports have described the relationship between blood flow and the recirculation rate [5,6], the relationship between RI and the recirculation rate has not yet been clarified.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between resistance index and recirculation rate in vascular access

et al. 2022

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Background The state of vascular access affects the efficiency of hemodialysis. Poor blood flow of vascular access causes recirculation, which reduces treatment efficiency. In the clinical setting, the resistance index (RI) is a commonly used parameter to evaluate the state of vascular access. However, there are few reports investigating the direct relationship between RI and the recirculation rate. In this study, the relationship between RI and the recirculation rate was investigated using computational fluid dynamics analysis. Methods We created a three-dimensional model that mimics vascular access in hemodialysis patients. Next, we input various blood flow waveforms (RI 0.00, 0.50, 0.60, 0.80, and 0.94) into the vascular model. Then, two needles were punctured into the blood vessel model. Blood was removed from the vessel by one needle at a rate of 200 ml/min and returned by the other needle at the same speed. The recirculation rate was calculated using the backflow from the blood return needle. Results The recirculation rates for the blood flow waveforms of RI 0.00, 0.50, 0.60, 0.80, and 0.94 were 0.00%, 0.29%, 0.44%, 11.6%, and 28.1%, respectively. The recirculation rate was higher for blood flow with higher RI. In addition, more recirculation occurred during the diastolic phase, when blood flow was slow. Conclusions When the minimum blood flow was slower than the hemodialysis blood removal speed, both backflow and the recirculation rate increased. Sufficient diastolic blood flow needs to be maintained to suppress recirculation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between resistance index and recirculation rate in vascular access

et al. 2022

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Features associated with arteriovenous fistula patency. A meta‐analysis

Zhang,

Liang,

Yang

2024

Hemodialysis International

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IntroductionIt is unclear if cannulation‐associated variables such as timing of first cannulation, access creation method, cannulation technique, or needle type are associated with the outcomes of arteriovenous fistulas. We conducted a meta‐analysis to investigate such potential associations with 1‐year primary patency.MethodsTwenty‐eight publications with titles that included “arteriovenous fistula,” “patency,” “cannulation,” “metric,” “first cannulation,” “hemodialysis,” “complication,” “vascular,” “nursing,” and “puncture” were retrieved and reviewed.FindingsThe 1‐year primary patency rates ranged from 0.32 to 0.93. Primary patency rates were significantly lower in patients in whom initial cannulation was done less than 1.5 months after fistula creation compared to fistulas first cannulated more than 1.5 months after anastomosis (odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.32–0.52). The effect of cannulation timing on primary patency rate was attenuated when plastic cannulas were used during the first two to three puncture weeks compared to metal needles (OR = 0.62 vs. 0.34; p = 0.032). Fistulas in the upper arm did not have a higher 1‐year primary patency compared to those in the forearm (OR = 1.05, 95% CI: 0.93–1.19). Primary patency of upper arm arteriovenous fistulas was higher in reports from the Americas or Europe compared to reports from Asia. Buttonhole cannulation was not associated with higher patency rates at 1 year compared to rope‐ladder cannulation (OR = 1.14, 95% CI: 0.75–1.71).DiscussionEarly cannulation was associated with reduced 1‐year arteriovenous fistula patency. This association was reduced when plastic cannulas were used during the initial 2–3 weeks.

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Effect of early cannulation with metal needles on arteriovenous fistula patency in patients undergoing hemodialysis

Jiang,

Liu,

Zhou

et al. 2024

J Vasc Access

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Background: Autogenous arteriovenous fistula (AVF) is the preferred vascular access mode. However, the earliest possible time for AVF puncture and whether premature puncture affects the AVF patency rate remain unclear. Methods: In this multicenter retrospective cohort study, adult uremic patients who underwent AVF surgery for the first time at Taizhou Hospital or Enze Hospital of Zhejiang Province between September 1, 2018 and August 31, 2021 were enrolled. All patients were followed up for 1 year after puncture, and the status of fistula establishment and puncture, subsequent patency, loss to follow-up, renal transplantation, conversion to peritoneal dialysis, abandonment of the fistula, and death, were recorded. Results: A total of 465 patients with AVFs were included in this study, including 59 (12.7%) patients with fistulas that were cannulated within 30 days. In the early puncture group, the levels of serum creatinine and urea nitrogen were higher, while the levels of hemoglobin and albumin were lower, suggesting that these patients needed urgent dialysis. Furthermore, the rate of non-cuffed catheter use was higher, while the rate of cuffed catheter use was lower, and femoral vein puncture was preferred over internal jugular vein puncture. The mean duration of catheter indwelling was shorter in the early puncture group (19 vs 70 days, p < 0.001). The estimated AVF primary and cumulative functional patency at 12 months was 81.1% versus 82.3% and 98.3% versus 98.7% in the early puncture and control groups, respectively. Kaplan–Meier analysis revealed no significant difference in AVF primary and cumulative functional patency between the two groups. Conclusions: In patients with an established fistula in urgent need of hemodialysis, to avoid new catheterization, a puncture can be performed within 30 days in those with well-developed blood vessels after adequate ultrasound and clinical evaluation without affecting the patency of the fistula.

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Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula

Cited by 4 publications

References 27 publications

Relationship between resistance index and recirculation rate in vascular access

Relationship between resistance index and recirculation rate in vascular access

Features associated with arteriovenous fistula patency. A meta‐analysis

Effect of early cannulation with metal needles on arteriovenous fistula patency in patients undergoing hemodialysis

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