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Arteriovenous Access Outcomes and Risk of Major Cardiovascular Events in Patients with Reduced Ejection Fraction: A

Nehal Naseer1, Nadeem Ahmed Siddiqui1, Fareed Ahmed Shaikh1

  • 1Section of Vascular Surgery, Aga Khan University Hospital, Karachi, Pakistan.

JPMA. the Journal of the Pakistan Medical Association
|June 27, 2026
PubMed

Insights

Ejection fraction did not significantly affect arteriovenous fistula patency in end-stage renal disease patients. However, normal ejection fraction was linked to higher major adverse cardiovascular events, suggesting complex interactions needing more study.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Surgery

Background:

  • End-stage renal disease (ESRD) necessitates vascular access for hemodialysis.
  • Arteriovenous fistula (AVF) is the preferred access, but maturation and patency can be affected by patient comorbidities.
  • Ejection fraction (EF), a measure of heart function, is a key comorbidity in ESRD patients.

Purpose of the Study:

  • To investigate the relationship between preoperative ejection fraction and AVF maturation and patency in ESRD patients.
  • To determine the incidence of major adverse cardiovascular events (MACE) following AVF creation in relation to EF.

Main Methods:

  • Retrospective cohort study of 127 ESRD patients undergoing AVF creation (January 2015 - December 2020).
  • Patients categorized into normal EF (Group A) and abnormal EF (Group B) based on American College of Cardiology guidelines.
  • Analysis of demographics, procedural data, AVF patency, and MACE within one year post-surgery.

Main Results:

  • AVF patency rates were comparable between normal EF (81.5%) and abnormal EF (88.6%) groups.
  • Major adverse cardiovascular events were significantly higher in the normal EF group (39.1%) compared to the abnormal EF group (12.6%).
  • Stroke occurred only in the normal EF group (6.5%); non-ST elevation myocardial infarction was the most frequent cardiac event in both groups.

Conclusions:

  • Preoperative ejection fraction did not significantly impact AVF patency in ESRD patients.
  • A trend towards lower patency was observed with increasing EF dysfunction.
  • The elevated MACE risk in normal EF patients highlights a complex interplay of factors requiring further investigation.
Abstract

Keywords:
End-stage renal disease, AVF patency, Ejection fraction, MACE, Haemodialysis access.

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