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Abstract: FR-PO718

Intermittent Pneumatic Compression Devices Assists in Vascular Access Selection: A Hierarchical Regression Model Study

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Author

  • Singh, Tej M., El Camino Hospital, Los Altos Hills, California, United States

Group or Team Name

  • Fist Assist Research Team
Background

Arteriovenous fistulas (AVF) are the preferred type of vascular access for hemodialysis patients. Among AVF, radiocephalic fistulas (RCF) are recommended. RCF placement has dropped in the USA to low rates. The aim of the present study is to determine if the use of a novel intermittent compression device can assist in vascular acces fistula selection.

Methods

After AVF creation, an intermittent pneumatic compression device enabling 60 mm Hg of cyclic compression was worn proximal to AVF intermittently for 6 hours daily for 3 months. Patients in the treatment group (n=41) wore the device. Twenty-four (n=24) had BCF, while seventeen (n=17) had RCF. Controls (n=12) used a sham device. Vein size was measured at baseline and at 3 months by duplex. Percentage increase was tested for significance.Hierarchical regression models were developed to model vein size dilation based on factors such as patient group , fistula type (BCF or RCF), the interaction between patient group and fistula type, and patient demographics.

Results

The interaction effect between patient group and fistula type was found to be significant.In a stepwise regression procedure, the first term enteresd in the model is the interaction between patient group and AVF type. At a proximal distance of 5 cm and 10 cm, the interaction term was highly significant (p <.01). Vein size increase is affected by patient group (treatment vs. control) as well as the type of fistula created for vascular access.The type of fistula created for vascular access, has an interaction effect with patient-group type (treatment vs. control) in affecting vein size dilation

Conclusion

The use of a novel, pneumatic compression device has significant impact on the recommended guidelines for vascular access selection. For patients who use the non-invasive device, a larger vein size dilation is achieved with a radiocephalic fistula. Novel, pneumatic devices may assist in RCF placement in the future.

Hierarchical regression modeling at 5 cm of fistula