Vein diameter is the major predictor of fistula maturation
| Autor: | Kaoru R. Goshima, Angelika C. Gruessner, Le Ann Chavez, Joseph L. Mills, Daniel M. Ihnat, Lannery S. Lauvao |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Fistula Venography Arteriovenous fistula Physical examination Kaplan-Meier Estimate Risk Assessment Veins Upper Extremity Young Adult Arteriovenous Shunt Surgical Predictive Value of Tests Renal Dialysis Risk Factors Medicine Humans Treatment Failure Child Vascular Patency Aged Retrospective Studies Aged 80 and over Univariate analysis Ultrasonography Doppler Duplex medicine.diagnostic_test business.industry Retrospective cohort study Vascular surgery Middle Aged medicine.disease Surgery Logistic Models Treatment Outcome Predictive value of tests Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of vascular surgery. 49(6) |
| ISSN: | 1097-6809 |
| Popis: | Objectives Preoperative duplex ultrasound mapping of veins and arteries has been widely advocated to maximize the creation of native arteriovenous fistula (AVF) for hemodialysis access, but reliable diameter criteria have not been established. We sought to determine patient and anatomic variables predictive of fistula maturation in patients receiving their initial permanent hemodialysis access. Methods All patients undergoing dialysis access creation from January 2003 to June 2007 were retrospectively reviewed. We analyzed fistula type and functional maturation rates (Society for Vascular Surgery [SVS] reporting standards) based on patient characteristics and findings on physical examination, preoperative vein mapping studies, or venography. Maturation and patency rates were determined by Kaplan Meier analysis. The following factors were analyzed: age, race, gender, body-mass index (BMI), fistula site, preoperative duplex vein diameter, diabetes, hyperlipidemia, HTN, prior central catheter placement, HIV, and history of IV drug abuse. Results From January 2003 to June 2007, 298 vascular access procedures were performed. One hundred ninety-five (65%) were initial hemodialysis access procedures, among which a native AVF was created in 185 (95%); 158 patients with posterior radiocephalic AVF (PRCAVF, n=24), wrist radiocephalic AVF (WRCAVF, n=72), or brachiocephalic AVF (BCAVF, n=62) had adequate follow-up and were included in the analysis. PRCAVF, WRCAVF, and BCAVF had 54%, 66%, and 81% maturation rates, respectively. Both the type of fistula type ( P = .032) and vein size ( P = .002) significantly affected maturation by univariate analysis. In contrast, by multivariate logistic regression analysis, vein diameter was the sole independent predictor of fistula functional maturation ( P = .002). Conclusion In this series of 158 patients undergoing initial hemodialysis access creation, native AVF creation was performed in 95%. In contrast to previous reports, age, gender, diabetes, and BMI had no significant effect on functional maturation. By multivariate logistic regression analysis, vein diameter was the sole independent predictor of functional fistula maturation. |
| Databáze: | OpenAIRE |
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