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International Angiology 2018 August;37(4):310-4

DOI: 10.23736/S0392-9590.18.03927-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 Department of Nephrology, Trás-os-Montes e Alto Douro Hospital Centre, Vila Real, Portugal; 2 Department of Vascular Surgery, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Barcelona, Spain; 3 Department of Nephrology, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí I3PT, Autonomous University of 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 preoperative mapping (morphology and hemodynamic), were collected. End-points were early failure and secondary patency by Kaplan-Meier.
RESULTS: The study included 117 patients with native AVF. 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: Thrombosis - Arteriovenous fistula - Ultrasonography, doppler

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