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Abstract: FR-PO714

Use of Smaller Vessels to Create an AVF Increases the Need for Interventions to Promote Its Maturation

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Farrington, Crystal A., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Robbin, Michelle L., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Lee, Timmy C., Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Allon, Michael, University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Preoperative vascular mapping using ultrasound (US) is often used to aid in the creation of an arteriovenous fistula (AVF). Current vascular access guidelines recommend minimal arterial and venous diameters of 2.0 mm and 2.5 mm, respectively, to optimize overall (assisted and unassisted) AVF maturation. However, the relationship of preoperative US measurements with unassisted AVF maturation (successful use without a prior intervention) has not been evaluated.

Methods

We reviewed the clinical, demographic, and preoperative mapping ultrasound information of 189 hemodialysis patients from a large dialysis center who received new upper extremity AVFs from 2010-16. We then evaluated the association of preoperative US measurements of venous diameter, arterial diameter, and brachial blood flow with two AVF outcomes: unassisted AVF maturation and overall AVF maturation.

Results

The mean age of the study population was 53 years. 58% of the patients were male, 81% were black, 57% were diabetic, and 48% were obese. 74% of the AVFs were located in the upper arm. Progressive increases in preoperative arterial diameter, venous diameter and brachial artery blood flow were each associated with corresponding increases in unassisted AVF maturation. Incremental increases in preoperative arterial diameter and blood flow were likewise associated with progressive increases in overall AVF maturation. In contrast, there was no significant association between preoperative venous diameter and overall AVF maturation (Table 1). Finally, the proportion of AVFs requiring assisted maturation was 52, 32, 31, and 22% when the preoperative arterial diameter was < 3, 3-3.9, 4-4.9, and ≥ 5 mm, respectively.

Conclusion

Preoperative arterial diameter and blood flow are associated significantly with both unassisted and overall AVF maturation. Preoperative venous diameter is associated with unassisted, but not with overall, AVF maturation. Use of smaller vessels to create an AVF increases the need for interventions to promote its maturation.

Table 1. Preoperative arterial diameter, venous diameter, and brachial artery blood flow and their associated AVF outcomes.

Funding

  • NIDDK Support