Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development

Area of Science:

• Vascular Surgery
• Nephrology
• Cardiovascular Physiology

Background:

• Arteriovenous fistula (AVF) maturation failure is a leading cause of dysfunction in dialysis vascular access.
• Predicting AVF maturation is crucial for improving patient outcomes and reducing complications.

Purpose of the Study:

• To determine if preoperative vascular functional properties predict postoperative AVF measurements.
• To identify specific vascular function tests (VFTs) that correlate with successful AVF development.

Main Methods:

• Patients in the Hemodialysis Fistula Maturation Study underwent five VFTs: FMD, NMD, pulse wave velocity (carotid-femoral and carotid-radial), and venous occlusion plethysmography.
• Mixed effects multiple regression analyses related VFTs to ultrasound measurements of AVF blood flow rate and venous diameter at 1 day, 2 weeks, and 6 weeks post-AVF placement.
• Analyses controlled for AVF location, preoperative ultrasound data, and demographic factors.

Main Results:

• Greater nitroglycerin-mediated dilation (NMD) was significantly associated with higher 6-week AVF blood flow rate and diameter.
• Greater flow-mediated dilation (FMD) also correlated with increased 6-week AVF blood flow rate and diameter.
• Other tested VFTs did not show consistent significant relationships with both postoperative AVF blood flow rate and diameter.

Conclusions:

• Preoperative NMD and FMD are valuable predictors of AVF maturation.
• Native arterial functional properties, assessed by NMD and FMD, influence AVF development and success.
• These findings suggest incorporating VFTs into preoperative assessments for AVF creation.