The use of AVF.SIM system for the surgical planning of arteriovenous fistulae in routine clinical practice

Abstract

Background: The number of patients treated with hemodialysis (HD) in Europe is more than half a million and this number increases annually. The arteriovenous fistula (AVF) is the vascular access (VA) of first choice, but the clinical outcome is still poor. A consistent number of AVFs fails to reach the desired blood flow rate for HD treatment, while some have too high flow and risk for cardiac complications. Despite the skill of the surgeons and the possibility to use Ultrasound investigation for mapping arm vasculature, it is still not possible to predict the blood flow volume that will be obtained after AVF maturation. Methods: We evaluated the potential of using a computational model (AVF.SIM) to predict the blood flow volume that will be achieved after AVF maturation, within a multicenter international clinical investigation aimed at assessing AVF.SIM predictive power. The study population included 231 patients, with data on AVF maturation in 124 patients, and on long-term primary patency in 180 patients. Results: At 1 year of follow-up, about 60% of AVFs were still patent, with comparable primary patency in proximal and distal anastomosis. The correlation between predicted and measured blood flow volume in the brachial artery at 40 days after surgery was statistically significant, with an overall correlation coefficient of 0.58 ( p < 0.001). The percent difference between measured and predicted brachial blood flow 40 days after surgery was less than 30% in 72% of patients investigated. Conclusions: The results indicate that the use of the AVF.SIM system allowed to predict with a good accuracy the blood flow volume achievable after VA maturation, for a given location and type of anastomosis. This information may help in AVF surgical planning, reducing the AVFs with too low or too high blood flow, thus improving AVF patency rate and clinical outcome of renal replacement therapy.

How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies

“…Another series of reports is dedicated to the designed coexistence of CIED system and haemodialysis (Hickson et al, 2014;Lin et al, 2016;Urja et al, 2019), especially in patients dialysed with permanent catheters (Guha et al, 2015;Saad & Weiner, 2017;23) infection, catheter-related infection, catheter infection, postoperative venous access occlusion, central vein stenosis, catheter damage or dysfunction, thrombotic occlusion of the catheter) (Asif et al, 2012;Bozzetto et al, 2022;Guha et al, 2015;Jeong et al, 2018;Kusztal & Nowak, 2018;Lin et al, 2016;Nowak & Kusztal, 2021;Saad & Weiner, 2017;Saad et al, 2013;Saad et al, 2015;Sgroi et al, 2019;Sohail et al, 2021;Spatola et al, 2021;Tan et al, 2013;Urja et al, 2019). Most of the above-mentioned reports concern infection prevention and management.…”

“…Some reports or guidelines consider the appearance of intraoperative complications (haemothorax, hemopneumothorax, pneumothorax nerve damage, arterial puncture and hematoma) and postoperative or late complications of HC implantation (thrombosis, infection, catheter‐related infection, catheter infection, postoperative venous access occlusion, central vein stenosis, catheter damage or dysfunction, thrombotic occlusion of the catheter) (Asif et al, 2012 ; Bozzetto et al, 2022 ; Guha et al, 2015 ; Jeong et al, 2018 ; Kusztal & Nowak, 2018 ; Lin et al, 2016 ; Nowak & Kusztal, 2021 ; Saad & Weiner, 2017 ; Saad et al, 2013 ; Saad et al, 2015 ; Sgroi et al, 2019 ; Sohail et al, 2021 ; Spatola et al, 2021 ; Tan et al, 2013 ; Urja et al, 2019 ). Most of the above‐mentioned reports concern infection prevention and management.…”

“…The number of haemodialyses treated patients in Europe, which is more than half a million annually, is increasing (Bozzetto et al, 2022 ). More than 3 million cardiovascular implantable electronic devices (CIED) are implanted every year (Wadhwani et al, 2021 ), and lead‐related venous obstructions are common in CIED carriers (Czajkowski et al, 2021a , 2021b ).…”

“…The number of haemodialyses treated patients in Europe, which is more than half a million annually, is increasing (Bozzetto et al, 2022).…”

Surgical planning of arteriovenous fistulae in routine clinical practice: A machine learning predictive tool

“…Many AVFs fail in the first months after surgical intervention, and the incidence of primary AVF failure within 1-year is about 40%. 3 Clinical Guidelines recommend an extensive and standardized preoperative Doppler Ultrasound (DUS) evaluation of the upper extremity vascular tree 4 to select the most suitable site for AVF creation. However, DUS examination cannot predict BFV and vessel diameter after AVF maturation, and therefore it cannot inform the surgeon on the AVF clinical outcome.…”