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Autogenous Vascular Access in American Indians.
Kelly Kempe1, Peter R Nelson1, Nasir Mushtaq2
1Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
Annals of Vascular Surgery
|December 26, 2021
Summary
Arteriovenous fistulas can be safely created in American Indian (AI) patients, even with high rates of diabetes and obesity. These fistulas provide functional vascular access for hemodialysis, improving outcomes for this population.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- American Indians (AI) experience higher rates of diabetes and obesity, increasing challenges for vascular access creation.
- Diabetes is a leading cause of end-stage renal disease in AI patients.
- Autogenous arteriovenous fistulas (AVFs) are preferred for hemodialysis but are more difficult to create in patients with diabetes and obesity.
Purpose of the Study:
- To review the outcomes of AVF creation in AI patients undergoing hemodialysis.
- To assess the safety and functionality of AVFs in an AI population with prevalent risk factors for vascular access.
Main Methods:
- A 10-year review of a vascular access database for consecutive new AI patients.
- Ultrasound vessel mapping performed by the operating surgeon prior to access creation.
- Analysis of primary and cumulative patency rates, patient survival, and factors associated with outcomes.
Main Results:
- 235 AI patients underwent autogenous AVF creation; 85% had diabetes, 27% were obese.
- Primary patency at 12/24 months was 62%/46%, cumulative patency was 96%/94%.
- Female gender, previous access operations, and obesity were associated with lower patency. Distal radial artery inflow AVFs correlated with longer patient survival.
Conclusions:
- Safe and functional arteriovenous fistulas can be successfully created in American Indian patients.
- Despite higher prevalence of diabetes and obesity, AVFs are a viable option for hemodialysis vascular access in this population.
- Optimizing inflow artery selection may improve patient survival.
