PURPOSE: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. METHODS: This was a prospective observational study including 61 consecutive patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary patency at 12 months in patients with an immediate post-interventional blood flow above or below 600 ml/min. Primary patency was estimated using the Kaplan-Meier method with the standard error of the estimate. Multivariate Cox regression analysis was used to study the effect of blood flow and other potential predictor variables. RESULTS: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one-month increase]). Primary patency in group 1 (previous intervention(s)) was 34% ± 13% at 12 months. In group 2 (no previous intervention), primary patency at 12 months was 62% ± 9%. CONCLUSIONS: The results of this study do not provide scientific support for using the immediate hemodynamic outcome of an intervention as a prognostic factor for primary patency. Low fistula age and a history of previous intervention in particular were found to reduce primary patency significantly.
PURPOSE: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. METHODS: This was a prospective observational study including 61 consecutive patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary patency at 12 months in patients with an immediate post-interventional blood flow above or below 600 ml/min. Primary patency was estimated using the Kaplan-Meier method with the standard error of the estimate. Multivariate Cox regression analysis was used to study the effect of blood flow and other potential predictor variables. RESULTS: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one-month increase]). Primary patency in group 1 (previous intervention(s)) was 34% ± 13% at 12 months. In group 2 (no previous intervention), primary patency at 12 months was 62% ± 9%. CONCLUSIONS: The results of this study do not provide scientific support for using the immediate hemodynamic outcome of an intervention as a prognostic factor for primary patency. Low fistula age and a history of previous intervention in particular were found to reduce primary patency significantly.
Authors: Gerald A Beathard; Charmaine E Lok; Marc H Glickman; Ahmed A Al-Jaishi; Donna Bednarski; David L Cull; Jeffery H Lawson; Timmy C Lee; Vandana D Niyyar; Donna Syracuse; Scott O Trerotola; Prabir Roy-Chaudhury; Surendra Shenoy; Margo Underwood; Haimanot Wasse; Karen Woo; Theodore H Yuo; Thomas S Huber Journal: Clin J Am Soc Nephrol Date: 2017-07-20 Impact factor: 8.237