Predictors of early failure and secondary patency in native arteriovenous fistulas for hemodialysis

Yang

et al. 2022

Sci Rep

The aim of the current study was to determine the prevalence of anatomic variant in cephalic arch on preoperative mapping venography and evaluate patency rates and predictors of patency in patients with brachiocephalic fistulas. The prevalence of anatomic variant in cephalic arch was retrospectively evaluated in 1004 consecutive patients who underwent bilateral preoperative mapping venography from July 2006 to December 2018 in a single center. The overall prevalence of anatomic variant in cephalic arch was 17.2% (173/1004). For patency analysis, 128 patients with brachiocephalic fistulas were divided into two groups: a standard anatomy (SA) group (n = 97) and a variant anatomy (VA) group (n = 31). There were no significant differences in clinical characteristics between the two groups. The primary patency rate did not differ significantly between the two groups. The secondary patency rate was significantly (p = 0.009) lower in the VA group than in the SA group. Older age (HR 1.03; 95% CI 1.01–1.05; p = 0.007) was a negative predictor of primary patency, and antiplatelet agent (HR 0.53; 95% CI 0.33–0.84; p = 0.007) and large-diameter cephalic vein (HR 0.52; 95% CI 0.31–0.86; p = 0.012) were positive predictors of primary patency. Older age (HR 1.04; 95% CI 1.01–1.07; p = 0.011) and anatomic variant in cephalic arch (HR 2.9; 95% CI 1.19–7.06; p = 0.019) were negative predictors of secondary patency. The current study provides insight into the clinical significance of anatomic variant in cephalic arch. Anatomic variant in cephalic arch should be considered as a potential risk factor for decreased patency of brachiocephalic fistula during preoperative planning.

Section: Discussionsupporting

confidence: 88%

Prevalence and clinical significance of anatomic variant in cephalic arch on preoperative mapping venography

Yang

et al. 2022

Sci Rep

“…In another study, distal arterial hemodynamics showed prognostic value in native AVF secondary patency rate. 16 In respect of postoperative PI at near 6 weeks after surgery, it showed that lower values were predictive of better outcomes and fistula maturation. This is in concurrency with few data already published.…”

Section: Discussionmentioning

confidence: 96%

New hemodynamic variables as predictors of arteriovenous fistula maturation

Abreu

2022

Seminars in Dialysis

Self Cite

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.

“…Karanan et al 17 analyzed AVF outcomes according to the arterial PSV value on postoperative days 1 and 8, confirming that PSV was a significant predictor of AVF outcome. Similarly, Abreu et al 18 conducted a 5-year follow-up study that demonstrated that PSV in ulnar and radial arteries had predictive value for secondary patency.…”

Section: Discussionmentioning

confidence: 99%

“…Karanan et al 17 analisaram o desfecho das FAVs de acordo com o valor da VPS arterial nos dias 1 e 8 do pós-operatório, confirmando a VPS como preditor do desfecho da FAV de forma significativa. Em concomitância, Abreu et al 18 conduziram um estudo com acompanhamento de 5 anos que demonstrou VPS em artérias ulnar e radial como valor preditor para perviedade secundária.…”

Section: Discussionunclassified

O volume de fluxo e a velocidade de pico sistólico ao ultrassom vascular com Doppler intraoperatório como preditores de perviedade precoce na fístula arteriovenosa autógena para hemodiálise

et al. 2021

Resumo Contexto A insuficiência renal crônica é um problema de saúde pública mundial. A hemodiálise é a principal terapia renal substitutiva. As fístulas arteriovenosas (FAV) são uma possível escolha, mas apresentam altas taxas de falência. Objetivos Este estudo tem como objetivo avaliar a relação entre as variáveis hemodinâmicas ao ultrassom vascular com Doppler no intraoperatório e a perviedade precoce da FAV para hemodiálise. Métodos Tratou-se de um estudo prospectivo observacional. Os pacientes consecutivos foram submetidos a FAV com ultrassonografia vascular com Doppler em intraoperatório nos dias 1, 7, 30 e 60. Eles foram divididos em grupos quanto à presença ou não de perviedade primária e secundária, e o volume de fluxo (VF) e a velocidade de pico sistólico (VPS) foram comparados. Foram realizadas curvas receiver operating characteristic (ROC), com definição de valores de VPS e VF com sensibilidade (S) e especificidade (E). Resultados Foram analisados 47 pacientes, os quais preencheram os critérios de inclusão. Os valores de VPS e VF intraoperatório foram maiores nos pacientes com perviedade primária e secundária comparados àqueles com falência. Os seguintes valores apresentaram maiores sensibilidade e especificidade para predizer perviedade primária aos 30 dias: 106 cm/s para VPS venoso, S: 75%, E: 71,4%; e 290,5 mL/min para VF arterial, S: 80,6%, E: 85,7%. Para perviedade secundária aos 30 dias, foram observados: 106 cm/s para VPS arterial, S: 72,7%, E: 100%; e 230 mL/min para VF venoso, com S: 86,4%, E: 100%. Para a perviedade primária no 60º dia, foram observados: 106 cm/s para VPS venoso, S: 74,4%, E: 62,5%; e 290,5 mL/min para VF arterial, S: 80%, E: 75%. Conclusões A velocidade de pico sistólico e o VF ao ultrassom vascular com Doppler intraoperatório são preditores de perviedade precoce na FAV para hemodiálise.