Abstract: TH-PO772

Arterial Diameter Following AVF Creation May Predict Aneurysmal Formation

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Cahalane, Alexis Michael, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Sahani, Vivek G, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Irani, Zubin, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Cui, Jie, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Aneurysmal formation in arteriovenous fistulae (AVF), which is the preferred vascular access for hemodialysis in end-stage renal disease, can lead to insufficient hemodialysis, risk of rupture and access abandonment.

Methods

This retrospective chart review study looked at patients with AVF aneurysmal dilatation requiring surgical correction between 01/01/2014 and 07/30/2016. All fistulogram images were reviewed and the diameter of the feeding artery, venous outflow, maximum aneurysmal segment (AnS), and length of AnS were measured. Location of any stenotic lesions were also recorded.

Results

10 female and 17 male patients were identified. 21 patients (77.78%) had brachiocephalic fistula and 6 had radiocephalic fistula (22.22%). Mean interval between surgical creation of the AVF and access revision was 1411± 955days. On the first fistulogram, there was a significant correlation between diameter of feeding artery and diameter of fistula (r=0.51, p=0.02), the maximum diameter of the aneurysm (r=0.67,p=0.03) and the length of the AnS (r=0.92, p=0.0001). The most common venous outflow lesion was cephalic arch stenosis (64.7%), while 7 patients had no outflow stenosis. Interval between first recorded fistulogram and surgical revision was 818 days.
On the presurigical fistulagram the diameter of the artery was strongly correlated with the diameter of the artery in the first fistulogram (Figure 1A,p<0.05). Furthermore, the length of the AnS on the last fistulogram also correlated with the diameter of the artery in the first fistulogram (Figure 1B).

Conclusion

Aneurysm formation is a long-term complication of AVF. In AVF created using the cephalic vein, cephalic arch stenosis was the most common stenotic lesion. The diameter of the feeding artery at time of the first fistulogram can predict the likelihood of aneurysm formation and its calibre. AVF with relative larger arterial diameter should be closely monitored for aneurysm formation and early intervention may avoid loss of the access.