Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study
| Autor: | Christine S. Hwang, Kelly L. Hudkins, James S. Kaufman, D. Soares, Y. Trahan, J. Alster, G. Treiman, C. Snell, L. Stern, Joseph A. Vita, Glenn M. Chertow, H. Higgins, J. Mackrell, Alfred K. Cheung, Milena Radeva, D. Ihnat, C. Clark, S. Ke, O. Mandaci, Charles E. Alpers, James M. Kaufman, R. Alloway, J. Kundzins, Tomasz Wietecha, Ingemar Davidson, H. Feldman, Maurits A. Jansen, Michael Allon, Miguel A. Vazquez, C. Abts, Larry S. Kraiss, Tom Greene, M. Sarfati, Marina A Malikova, J. Hamlett, Liang Li, Harold I. Feldman, A. Pflum, K. Mangadi, Anatole Besarab, Richard M. Mortensen, M. Taylor, I. Lavasani, T. Lightfoot, T. Canaan, Thomas S. Huber, L. Manahan, J. Gravley, T. Louis, Brendan M. Weiss, B. Campos-Naciff, Bart Dolmatch, R. Munda, Jonathan Himmelfarb, Scott A. Berceli, Brett Larive, J. Rubin, Gerald J. Beck, M. El-Khatib, Wanpen Vongpatanasin, Mai-Ann Duess, G. McCaslin, Lesley A. Inker, Carlton J. Young, K. Brayman, Peter B. Imrey, Alik Farber, M. Maloney, C. Crawford, Aaron Levit, T. Huber, W. McClellan, Timmy Lee, L. Belt, Michelle L. Robbin, L. Schlotfeldt, Prabir Roy-Chaudhury, S. Behnken, L. Thieken, L. Woodard, D. Kinikini, Heidi Umphrey, A. Valencia, Charlotte Buchanan, Lauren F. Alexander, K. Wiggins, C. Livingston, Jennifer J. Gassman, John W. Kusek, M. Li, Nathaniel M. Hawkins, Robert A. Star, P. Imrey, Andrew Z. Fenves, Laura M. Dember, Denise Harrison, M. Diener-West, P. Lesage, Larry W. Kraiss, Naomi M. Hamburg, J. Wise, C. Kivork |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Time Factors Fistula medicine.medical_treatment 030232 urology & nephrology Comorbidity 030204 cardiovascular system & hematology 0302 clinical medicine Risk Factors Odds Ratio Prospective Studies Protamines Brachial artery Prospective cohort study Ultrasonography Doppler Duplex Graft Occlusion Vascular Heparin Antagonists Middle Aged Thrombosis Forearm Treatment Outcome medicine.anatomical_structure Female Hemodialysis Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Attitude of Health Personnel Arteriovenous fistula Article 03 medical and health sciences Arteriovenous Shunt Surgical Sex Factors Predictive Value of Tests Renal Dialysis medicine.artery medicine Humans Physical Examination Aged Surgeons business.industry Odds ratio Protective Factors medicine.disease United States Surgery Logistic Models Case-Control Studies business |
| Zdroj: | Journal of Vascular Surgery. 63:163-170.e6 |
| ISSN: | 0741-5214 |
| Popis: | Early thrombosis (ET) contributes to autogenous arteriovenous fistula (AVF) failure. We studied patients undergoing AVF placement in the Hemodialysis Fistula Maturation Study, a prospective, observational cohort study, using a nested case-control analysis to identify preoperative and intraoperative predictors of ET.ET cases were compared with controls, who were matched for gender, age, diabetes, dialysis status, and surgeon fistula volume. ET was defined as thrombosis diagnosed by physical examination or ultrasound within 18 days of AVF creation. Conditional logistic regression models were fit to identify risk factors for ET.Thirty-two ET cases (5.3%) occurred among 602 study participants; 198 controls were matched. ET was associated with female gender (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.19-6.38; P = .018), fistula location (forearm vs upper arm; OR, 2.76; 95% CI, 1.05-7.23; P = .039), feeding artery (radial vs brachial; OR, 2.64; 95% CI, 1.03-6.77; P = .043) and arterial diameter (OR, 1.52; 95% CI, 1.02-2.26; P = .039, per mm smaller). The draining vein diameter was nonlinearly associated with ET, with highest risk in 2- to 3-mm veins. Surprisingly, ET risk was lower in diabetics (OR, 0.19; 95% CI, 0.07-0.47; P = .0004), lower with less nitroglycerin-mediated brachial artery dilation (OR, 0.42; 95% CI, 0.20-1.92; P = .029 for each 10% lower) and higher with lower carotid-femoral pulse wave velocity (OR, 1.49; 95% CI, 1.02-2.20; P = .041, for each m/s lower). Intraoperative protamine use was associated with a higher ET risk (OR, 3.26; 95% CI, 1.28-∞; P = .038). Surgeon's intraoperative perceptions were associated with ET: surgeons' greater concern about maturation success (likely, marginal, unlikely) was associated with higher thrombosis risk (OR, 8.09; 95% CI, 4.03-∞; P.0001, per category change), as were absence vs presence of intraoperative thrill (OR, 21.0; 95% CI, 5.07-∞; P = .0001) and surgeons' reported frustration during surgery (OR, 6.85; 95% CI, 2.70-∞; P = .0004). Decreased extent of intraoperative thrill (proximal, mid or distal third of the forearm or upper arm, based on AVF placement) was also associated with ET (OR, 2.91; 95% CI, 1.31-∞; P = .007, per diminished level). Oral antithrombotic medication use was not significantly associated with ET.ET was found to be associated with female gender, forearm AVF, smaller arterial size, draining vein diameter of 2 to 3 mm, and protamine use. Paradoxically, diabetes and stiff, noncompliant feeding arteries were associated with a lower frequency of ET. Absent or attenuated intraoperative thrill, and both surgeon frustration and concern about successful maturation during surgery, were correlated strongly with ET. |
| Databáze: | OpenAIRE |
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