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Contemporary Strategies to Promote Dialysis Access Fistula Maturation.
Jillian P Walsh1, Dirk M Hentschel2, Gaurav Sharma1
11863Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA.
Vascular and Endovascular Surgery
|May 16, 2022
Summary
Arteriovenous fistula non-maturation leads to complications. This study presents algorithms using physical exams, ultrasound, and fistulograms to identify issues and optimize fistula maturation with endovascular or open techniques.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Arteriovenous fistulas (AVFs) are crucial for hemodialysis access.
- Non-maturation of newly created AVFs leads to complications and reliance on central venous catheters.
- Management approaches vary widely among different surgical and medical specialties.
Purpose of the Study:
- To describe a standardized algorithmic approach for managing AVF non-maturation.
- To provide guidance for trainees and clinicians managing this complex clinical problem.
Main Methods:
- Utilized a combination of physical examination, selective duplex ultrasound, and fistulogram.
- Developed and applied a collection of management algorithms.
Main Results:
- Physical examination, duplex ultrasound, and fistulogram effectively identify most pathologies causing AVF non-maturation.
- The described algorithms have proven effective in managing AVF non-maturation.
Conclusions:
- Diagnostic tools like ultrasound and fistulography are key to identifying AVF non-maturation causes.
- Both endovascular and open surgical techniques can be successfully employed to improve AVF maturation rates.
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