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Abstract: SA-PO1099

Outcomes of Upper Limb Arteriovenous Fistula After Insertion of Ipsilateral vs. Contralateral Tunnelled Vascular Catheters: A Single-Centre Experience

Session Information

  • Vascular Access - II
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Diep, Jason, Liverpool Hospital, Greenfield Park, New South Wales, Australia
  • Makris, Angela, Liverpool Hospital, Greenfield Park, New South Wales, Australia
  • De Guzman, Imelda, Liverpool Hospital, Greenfield Park, New South Wales, Australia
  • Wong, Jeffrey, Liverpool Hospital, Greenfield Park, New South Wales, Australia
  • Aravindan, Ananthakrishnapuram N., Liverpool Hospital, Greenfield Park, New South Wales, Australia
  • Narayanan, Govind Surya, Liverpool Hospital, Greenfield Park, New South Wales, Australia
Background

Observational data suggest that the use of central venous dialysis catheters is associated with reduced subsequent Arteriovenous Fistula (AVF) maturation and survival, but it’s unclear if catheters directly affect AVF function. Catheter related central vein stenosis could affect flow and maturation of a subsequent AVF on the same side. To explore this further we aim to compare the outcomes of AVF created ipsilateral or contralateral to previous Tunnelled Vascular Catheters (TVC).

Methods

We retrospectively examined our vascular access database and electronic medical records of all patients who started dialysis at all units linked to Sydney Southwest Local Health District. We identified 142 patients who started dialysis with a TVC and subsequently had their first AVF created between Jan 2013 and Dec 2017. For patients with multiple AVFs only the first was included. All fistulas were monitored as per local policy. Successful fistula use (cannulated with two needles for ≥ 2 consecutive weeks) was analysed at 6 and 12 months after initial creation. We used Chi-Square test and logistic regression to analyse outcomes.

Results

40 AVFs (12 upper arm, 33 right arm) were created ipsilateral to previous TVC insertion side and 102 AVFs (31 upper arm, 5 right arm) were contralateral. Median age (68 years, range=28-84; 66 years, range=25-87; p=0.38), the proportion of males (77.5% and 68.6%, p=0.29), and prevalence of diabetes (60.0% and 63.7%, p=0.70) were similar between ipsilateral and contralateral groups respectively. At 6 months, 40.0% of ipsilateral AVFs were functioning compared to 59.6% of contralateral AVFs (OR=0.45, CI=0.21-0.99, p<0.05). After adjusting for other factors (age, sex, diabetes, and hypertension) using a backwards conditional regression, non-smokers (p=0.005) and contralateral AVF placement (p=0.021) were associated with a greater AVF function at 6 months. There was no difference in functioning AVFs at 12 months (57.6% ipsilateral versus 65.9% contralateral, OR=0.70, CI=0.31-1.61, p=0.41).

Conclusion

Successful use of AVF was lower at 6 months in patients with AVF created ipsilateral to prior TVC insertion. Careful planning of prior TVC and future AVF locations should be guide management of long term vascular access.