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Related Experiment Video

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The arteriovenous access stage (AVAS) classification.

Peter Baláž1,2, Jennifer Hanko3, Hannah Magowan3

  • 1Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.

Clinical Kidney Journal
|July 5, 2021
PubMed
Summary

A new Arteriovenous Access Stages (AVAS) classification simplifies vascular access planning for hemodialysis patients. This system, based on upper extremity anatomy, demonstrates high reliability for surgical access suitability.

Keywords:
arteriovenous fistulaarteriovenous graftclassificationhaemodialysisvascular access

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Medical Classification Systems

Background:

  • Individual patient anatomy presents unique challenges for creating arteriovenous access.
  • Effective vascular access is crucial for patients requiring hemodialysis.
  • Current methods for assessing suitability for surgical access can be complex.

Purpose of the Study:

  • To introduce a novel classification system for patients needing upper extremity arteriovenous access for hemodialysis.
  • To simplify communication regarding surgical access options based on patient vascular anatomy.
  • To enhance the planning and execution of vascular access procedures.

Main Methods:

  • Developed the Arteriovenous Access Stages (AVAS) classification based on patient vascular anatomy in both upper extremities.
  • Validated the AVAS system using ultrasound-assessed arteriovenous maps from 70 patients.
  • Employed three blinded observers to assess inter-rater reliability, with sample size calculations supporting robust validation.

Main Results:

  • The AVAS classification system successfully categorized all evaluated patients.
  • Achieved a high inter-rater reliability with a Fleiss' Kappa coefficient of 0.94.
  • Demonstrated significant agreement among observers, confirming the system's consistency.

Conclusions:

  • The AVAS classification provides a simplified and effective method for communicating vascular access options.
  • The system's high inter-rater reliability supports its clinical utility in surgical planning.
  • AVAS facilitates better-informed decisions for creating suitable arteriovenous access based on individual vascular anatomy.