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Simple Predictive Model of Early Failure among Patients Undergoing First-Time Arteriovenous Fistula Creation.

Abstract：

BACKGROUND:Native arteriovenous fistulas (AVFs) have a high 1 year failure rate leading to a need for secondary procedures. We set out to create a predictive model of early failure in patients undergoing first-time AVF creation, to identify failure-associated factors and stratify initial failure risk. METHODS:The Vascular Study Group of New England (VSGNE) (2010-2014) was queried to identify patients undergoing first-time AVF creation. Patients with early (within 3 months postoperation) AVF failure (EF) or no failure (NF) were compared, failure being defined as any AVF that could not be used for dialysis. A multivariate logistic regression predictive model of EF based on perioperative clinical variables was created. Backward elimination with alpha level of 0.2 was used to create a parsimonious model. RESULTS:We identified 376 first-time AVF patients with follow-up data available in VSGNE. EF rate was 17.5%. Patients in the EF group had lower rates of hypertension (80.3% vs. 93.2%, P = 0.003) and diabetes (47.0% vs. 61.3%, P = 0.039). EF patients were also more likely to have radial artery inflow (57.6% vs. 38.4%, P = 0.011) and have forearm cephalic vein outflow (57.6% vs. 36.5%, P = 0.008). Additionally, the EF group was noted to have significantly smaller mean diameters of target artery (3.1 ± 0.9 vs. 3.6 ± 1.1, P = 0.002) and vein (3.1 ± 0.7 vs. 3.6 ± 0.9, P < 0.001). Multivariate analyses revealed that hypertension, diabetes, and vein larger than 3 mm were protective of EF (P < 0.05). The discriminating ability of this model was good (C-statistic = 0.731) and the model fits the data well (Hosmer-Lemeshow P = 0.149). β-estimates of significant factors were used to create a point system and assign probabilities of EF. CONCLUSIONS:We developed a simple model that robustly predicts first-time AVF EF and suggests that anatomical and clinical factors directly affect early AVF outcomes. The risk score has the potential to be used in clinical settings to stratify risk and make informed follow-up plans for AVF patients.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Eslami MH,Zhu CK,Rybin D,Doros G,Siracuse JJ,Farber A

doi

10.1016/j.avsg.2016.01.023

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

46-52

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(16)30337-5

journal_volume

pub_type

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Simple Predictive Model of Early Failure among Patients Undergoing First-Time Arteriovenous Fistula Creation.