Abstract:
BACKGROUND:Arteriovenous fistulas (AVFs) are favored for hemodialysis (HD) access. However, in many instances, AVFs fail to mature. We examined the utility of postoperative color duplex ultrasound (CDU) in assessing AVF maturation and determining the need for balloon-assisted maturation (BAM). METHODS:A total of 633 patients underwent AVF creation at a single institution from 2015 to 2018. A total of 339 patients (54%) underwent CDU at a median of 8 weeks postoperatively. We collected the following parameters: vein diameter, volume flow (VF), peak systolic velocities in arterial inflow and venous outflow, and presence of stealing branches. A peak systolic velocity ratio (SVR) of ≥2 correlated with ≥50% stenosis in venous outflow, and SVR ≥3 correlated with ≥50% stenosis at the anastomosis. AVFs were considered mature when they were successfully cannulated on dialysis. A generalized linear mixed model (GLMM) was created to compare duplex criteria associated with successful use of AVF (maturation) to those AVFs that required further intervention or failed to mature. Fistulography images, the current gold standard, were compared with findings from CDU studies to determine validity of the duplex ultrasound. RESULTS:Of the 339 AVFs with postoperative CDU, 31.3% matured without interventions, 38.3% required BAM, 9.7% thrombosed, and the remaining patients were not yet on HD. Based on GLMM analysis, the probability of AVF maturation increases if CDU demonstrated one of the following: the vein diameter is ≥ 6 (odds ratio [OR] = 38.7), no evidence of stenosis in the venous outflow tract (OR = 35.6), no stealing branches (OR = 21.6) and VF ≥ 675 (OR = 5.0). Fistulography was performed in 195 patents. Sensitivity and specificity for each are as follows: vein diameter (84.3%, 28.6%), stenosis (59.3%, 78.8%), and stealing branches (20.7%, 92.7%). CONCLUSIONS:Postoperative CDU should be considered routine to correct anatomical findings that might limit AVF maturation and identify the need for further interventions.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Etkin Y,Talathi S,Rao A,Akerman M,Lesser M,Mussa FF,Landis GSdoi
10.1016/j.avsg.2020.10.006subject
Has Abstractpub_date
2020-11-21 00:00:00eissn
0890-5096issn
1615-5947pii
S0890-5096(20)30951-1pub_type
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:1991-09-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1016/j.avsg.2016.06.028
更新日期:2017-02-01 00:00:00
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pub_type: 杂志文章,多中心研究
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2002-05-01 00:00:00