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Predictive factors for arteriovenous fistula maturation: A prospective study
Ana Luisa Correia1, Ana Rita Silva1, Filipe Mira1,2
1Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.
Hemodialysis International. International Symposium on Home Hemodialysis
|December 18, 2024
Summary
Preoperative ultrasound mapping is key for arteriovenous fistula (AVF) success. Optimal vein and artery diameters are critical to prevent AVF maturation failure, guiding surgical site selection.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Biomarkers
Background:
- Arteriovenous fistula (AVF) maturation failure is a significant clinical challenge, even with preoperative ultrasound mapping.
- Identifying predictive biomarkers is essential to anticipate primary AVF failure and reduce the need for repeat interventions.
- This study investigated clinical and analytical risk factors associated with primary AVF failure or delayed maturation.
Purpose of the Study:
- To identify clinical and analytical risk factors for primary arteriovenous fistula (AVF) failure or delay.
- To establish predictive thresholds for vein and artery diameters to optimize AVF outcomes.
- To evaluate the impact of central venous catheters on AVF maturation.
Main Methods:
- A prospective study conducted from October 2022 to March 2023 included adult patients undergoing AVF creation.
- Preoperative ultrasound mapping was performed for all patients, with AVF maturation assessed at least six weeks post-surgery.
- Clinical, analytical, and demographic data were systematically collected and analyzed.
Main Results:
- Significant factors impacting primary AVF failure included preoperative vein and artery diameters at the distal anastomosis.
- For distal anastomosis, vein diameter cutoff of 3.25 mm (AUC 77.2%) and artery cutoff of 2.35 mm (AUC 74.6%) were identified.
- For proximal anastomosis, an artery diameter cutoff of 2.25 mm (AUC 76.5%) impacted AVF maturation; distal AVF creation correlated with higher failure risk. Central venous catheter use did not correlate with primary failure but was associated with higher inflammatory markers.
Conclusions:
- Preoperative evaluation, including ultrasound mapping and careful site selection based on vein and artery diameter thresholds, is crucial for successful AVF outcomes.
- Avoiding central venous catheters in suitable patients may positively influence AVF maturation and success rates.
- Specific diameter cutoffs for veins and arteries can predict AVF maturation success.
