Ultrasonographic Maturation of Native Arteriovenous Fistulae: A Follow-Up Study

Seyahi, Nurhan; Altıparmak, Mehmet Rıza; Tascilar, Koray; Pekpak, Meltem; Serdengeçtı, Kamıl; Erek, Ekrem

doi:10.1080/08860220701278026

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…The mean AVF vein diameter and blood flow rate increased progressively over 6 weeks, which is similar to findings from other small single-center studies in forearm (1-3,15,16) and upper-arm (17) AVFs. Interestingly, 55% of forearm AVFs and 83% of upper-arm AVFs reached at least 50% of the 6-week blood flow rate measurements at 1 day, which is similar to findings in three small previous studies (4,18,19), only one including upper-arm AVF. Collectively, our large data set and the literature indicate that substantial increases in blood flow and dilation of the vein occur within a day of AVF creation.…”

Section: Discussionsupporting

confidence: 78%

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Robbin¹,

Greene²,

Cheung³

et al. 2016

Radiology

111

114

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Section: Discussionsupporting

confidence: 78%

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Robbin¹,

Greene²,

Cheung³

et al. 2016

Radiology

111

114

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“…Flow rate increased from 1 day to 6 weeks and were predictive at each time point of AVF maturation. Increase in diameter and flow rate over time were also found in two other small single center studies in Eurasia [ n = 18, Lomonte et al ( 44 ); and n = 31, Seyahi et al ( 45 )]. In a single-center study in China, ultrasound was performed to 132 patients at 1, 14, 28, 42, 56, 70, and 84 days after AVF creation surgery.…”

Section: Discussionsupporting

confidence: 68%

Differential hemodynamics between arteriovenous fistulas with or without intervention before successful use

Northrup

et al. 2022

Front. Cardiovasc. Med.

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A significant number of arteriovenous fistulas (AVFs) fail to maturate for dialysis. Although interventions promote maturation, functional primary patency loss is higher for AVFs with interventions (assisted maturation) than AVFs without interventions (un-assisted maturation). Although blood flow-associated hemodynamics have long been proposed to affect AVF remodeling, the optimal hemodynamic parameters for un-assisted maturation are unclear. Additionally, AVF maturation progress is generally not investigated until 6 weeks after AVF creation, and the examination is focused on the AVF’s venous limb. In this exploratory study, patients (n = 6) underwent magnetic resonance imaging (MRI) at 1 day, 6 weeks, and 6 months after AVF creation surgery. Before successful use for hemodialysis, three AVFs required intervention and three did not. MRI of the AVFs were used to calculate lumen cross-sectional area (CSA) and perform computational fluid dynamics (CFD) to analyze hemodynamics, including velocity, wall shear stress (WSS), and vorticity. For the venous limb, the no-intervention group and intervention group had similar pre-surgery vein diameter and 1-day post-surgery venous CSA. However, the no-intervention group had statistically larger 1-day venous velocity (0.97 ± 0.67 m/s; mean ± SD), WSS (333 ± 336 dyne/cm2) and vorticity (1709 ± 1290 1/s) than the intervention group (velocity = 0.23 ± 0.10 m/s; WSS = 49 ± 40 dyne/cm2; vorticity = 493.1 ± 227 1/s) (P < 0.05). At 6 months, the no-intervention group had statistically larger venous CSA (43.5 ± 27.4 mm2) than the intervention group (15.1 ± 6.2 mm2) (P < 0.05). Regarding the arterial limb, no-intervention AVF arteries also had statistically larger 1-day velocity (1.17 ± 1.0 m/s), WSS (340 ± 423 dyne/cm2), vorticity (1787 ± 1694 1/s), and 6-month CSA (22.6 ± 22.7 mm2) than the intervention group (velocity = 0.64 ± 0.36 m/s; WSS = 104 ± 116 dyne/cm2, P < 0.05; vorticity = 867 ± 4551/s; CSA = 10.7 ± 6.0 mm2, P < 0.05). Larger venous velocity, WSS, and vorticity immediately after AVF creation surgery may be important for later lumen enlargement and AVF maturation, with the potential to be used as a tool to help diagnose poor AVF maturation earlier. However, future studies using a larger cohort are needed to validate this finding and determine cut off values, if any.

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“…Postoperative ultrasound measurements have been used to predict AVF clinical maturation in several small, single-center series, 10,11,[13][14][15][16][17][18][19][20][21] using brachial or radial artery, or AVF vein inner diameter measurements, and blood flow measured in varying locations of these arteries or the AVF vein, limiting comparability. Early AVF clinical maturation criteria, proposed by a 2002 University of Alabama study, focused on AVF blood flow and diameter.…”

mentioning

confidence: 99%

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Robbin¹,

Greene²,

Allon

et al. 2018

JASN

142

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Background The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, although maturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

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Ultrasonographic Maturation of Native Arteriovenous Fistulae: A Follow-Up Study

Cited by 14 publications

References 23 publications

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Differential hemodynamics between arteriovenous fistulas with or without intervention before successful use

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

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