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INTERNATIONAL ANGIOLOGY

A Journal on Angiology


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2018 Feb 08

DOI: 10.23736/S0392-9590.18.03927-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Predictors of early failure and secondary patency in native arteriovenous fistulas for hemodialysis

Rui ABREU 1, Sara RIOJA 2, Joaquin VALLESPIN 2, Xavier VINUESA 3, Ruben IGLESIAS 3, Jose IBEAS 3

1 Nephrology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal; 2 Vascular Surgery Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain;
3 Nephrology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain


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BACKGROUND: Native arteriovenous fistula (AVF) is considered the gold standard of vascular access for hemodialysis due to its longer survival, fewer complications, lower mortality and costs. Patency is important for effective dialysis treatment and this remains a challenge in nephrology. There are no well-defined prognostic factors for early and long-term AVF survival. The aim of this study was to evaluate comorbidity, analytical and ultrasound (US) variables as prognostic factors for early failure and AVF patency.
METHODS: A prospective single-center cohort study was conducted with 5 years of follow-up. Inclusion criteria were patients with new native AVF creation between January 2011 and December 2015 and known vascular access survival data at the end of follow-up. Comorbidity (blood pressure, severe arteriopathy, diabetes, Charlson index), and laboratory data (hemoglobin, calcium, phosphorus, PTH, ferritin, C-reactive protein), as well as US pre-operative mapping (morphology and hemodynamic), were collected. End-points were early failure and secondary patency by Kaplan-Meier.
RESULTS: 117 patients with native AVF were identified. Median age was 69±18 years and mainly of male gender (n=70, 59.8%). Hypertension, diabetes and severe vascular disease were present in 65 (86.7%), 38 (50.7%) and 31 (41.3%). In 55 patients (47.8%) the AVF was in a distal location. Early failure was 19.7% and secondary patency at 5 years was 66.7%. Elderly age (p=0.034) and vein diameter (p=0.041) had an impact on early AVF failure. Radial (p=0.006) and ulnar peak systolic velocity (PSV) (p=0.018) showed predictive value in native AVF secondary patency rate.
CONCLUSIONS: Predictors of early and late events are slightly different. Elderly age and vein diameter had greater impact on early AVF failure. However, distal arterial hemodynamics showed prognostic value in native AVF secondary patency rate.


KEY WORDS: Early failure - Thrombosis - Secondary patency - Arteriovenous fistula - Maturation - Doppler ultrasound

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Publication History

Article first published online: February 8, 2018
Manuscript accepted: February 7, 2018
Manuscript received: September 25, 2017

Cite this article as

Abreu R, Rioja S, Vallespin J, Vinuesa X, Iglesias R, Ibeas J. Predictors of early failure and secondary patency in native arteriovenous fistulas for hemodialysis. Int Angiol 2018 Feb 08. DOI: 10.23736/S0392-9590.18.03927-5

Corresponding author e-mail

jibeas@telefonica.net