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Published on: April 1, 2022
Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes
Mariah Buzzell1, Adrian Chen1, Tabea Hoffstaetter1
1Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Insights
Early follow-up for arteriovenous fistula (AVF) maturity assessment significantly reduces time to first cannulation and catheter-free hemodialysis (HD). This proactive approach optimizes AVF use for patients requiring dialysis.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous fistulas (AVFs) are crucial for hemodialysis (HD) access.
- Up to 60% of AVFs require interventions to mature, delaying HD initiation.
- Early postoperative assessment of AVF maturity is recommended to expedite dialysis readiness.
Purpose of the Study:
- To evaluate the impact of AVF follow-up timing on patient outcomes.
- To compare early (<8 weeks) versus delayed (>8 weeks) postoperative AVF assessment.
- To determine if early follow-up shortens time to cannulation and catheter-free dialysis.
Main Methods:
- Retrospective review of 400 patients undergoing AVF creation (2017-2021).
- Comparison of outcomes between early (<8 weeks) and delayed (>8 weeks) postoperative follow-up groups.
- Primary endpoints: time to first cannulation and time to catheter-free dialysis.
Main Results:
- Early follow-up group had significantly shorter median time to first cannulation (50 vs. 88 days) and catheter-free HD (75 vs. 118 days).
- Incidence of first cannulation at 4 months was higher in the early follow-up group (74% vs. 63%).
- Incidence of catheter-free dialysis at 4 months was also higher in the early follow-up group (65% vs. 50%).
Conclusions:
- Early postoperative AVF follow-up is associated with improved outcomes.
- This strategy significantly reduces the time to successful AVF cannulation for hemodialysis.
- Early assessment leads to a quicker transition to catheter-free dialysis.
Background:
Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes.
Methods:
All patients who underwent AVF creation between 2017 and 2021 in an academic medical center were retrospectively reviewed, excluding patients lost to follow-up or not on HD. Outcomes were compared between patients that had delayed follow-up to assess AVF maturity, >8 weeks post surgery, versus early follow-up, <8 weeks post-surgery. AVF evaluation for maturity consisted of physical examination and duplex ultrasound. Primary endpoints were time to first cannulation (interval from AVF creation to first successful cannulation) and time to catheter-free dialysis (interval from AVF creation to central venous catheter removal).
Results:
A total of 400 patients were identified: 111 in the delayed follow-up group and 289 in the early follow-up group. The median time to follow-up was 78 days (interquartile range [IQR], 66-125) in the delayed follow-up group versus 39 days (IQR, 36-47) in the early follow-up group, (P < 0.0001). The maturation rate was 87% in the delayed follow-up group versus 81% in the early follow-up group, (P = 0.1) and both groups had similar rates of interventions to assist maturation (66% vs. 57%, P = 0.2). The early follow-up group had a significantly shorter median time to first cannulation (50 vs. 88 days; P < 0.0001) and shorter time to catheter-free HD (75 vs. 118 days; P <0.0001). At 4 months after AVF creation, the incidence of first cannulation was 74% in the early follow-up group versus 63% in the delayed follow-up group (P = 0.001). Similarly, the incidence of catheter-free dialysis was 65% in the early follow-up group versus 50% in the delayed follow-up group at 4 months postoperatively, (P = 0.036).
Conclusions:
Early postoperative follow-up for evaluation of fistula maturation is associated with reduced time to first successful cannulation of AVF for HD and reduced time to catheter-free dialysis.
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