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Arteriovenous Fistula Maturation, Functional Patency, and Intervention Rates
Thomas S Huber1, Scott A Berceli1, Salvatore T Scali1
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville.
JAMA Surgery
|September 22, 2021
Summary
Autogenous arteriovenous fistulas (AVFs) are a viable hemodialysis access option. However, achieving and maintaining AVF patency often requires interventions to manage complications and facilitate maturation.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- National guidelines promote autogenous arteriovenous fistulas (AVFs) for hemodialysis.
- The efficacy and usability of AVFs have been subject to scrutiny.
Purpose of the Study:
- To evaluate AVF usability, long-term functional patency, and the role of remedial procedures.
- To identify factors influencing AVF maturation in the Hemodialysis Fistula Maturation (HFM) Study.
Main Methods:
- A prospective, multicenter cohort study involving 602 participants (380 with kidney failure, 222 with chronic kidney disease).
- AVF maturation was assessed, and functional patency was analyzed using Kaplan-Meier methods.
- Clinical decisions were center-specific, with interventions discouraged within the initial 6 weeks.
Main Results:
- AVF maturation rates at 12 months were 76% for kidney failure and 58% for CKD patients.
- Median maturation time was 115 days, varying by indication (CKD: 170 days; kidney failure: 105 days).
- Functional patency at 2 years was 75%; 47.5% of matured AVFs required further intervention for maintenance or complication management.
Conclusions:
- Autogenous arteriovenous fistulas are a suitable option for hemodialysis access.
- Both AVF maturation and sustained patency necessitate a significant number of interventions to address complications.
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