Yang Jin Park1, Peter Gloviczki2, Young-Wook Kim3, Junhyuk David Kwon4, Dong-Ik Kim5, Hye-Ryeon Jang6, Woo-Sung Heo6, Ha-Young Oh6. 1. Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. 2. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. 3. Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: ywkim@skku.edu. 4. Division of Transplantation Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5. Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 6. Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
OBJECTIVE: This study identified predictors affecting maturation and patency of autogenous radiocephalic arteriovenous fistulas (RCAVFs). METHODS: We retrospectively reviewed the prospectively collected clinical data of all patients who underwent primary RCAVF creation and evaluated the effect of clinical variables and findings of preoperative duplex ultrasound mapping on primary maturation and patency rates of RCAVFs. RESULTS: From August 2008 to December 2010, 383 vascular access procedures were performed in 371 patients; of these, 331 (86.4%) were autogenous AVFs, 283 (85.5%) were primary first AVFs, and 186 (65.7%) of these were RCAVFs. The primary maturation rate was 88.2% at a mean of 39 ± 24.1 days after the operation. By multiple logistic regression analysis, minimum cephalic vein (CV) diameter >2 mm was an independent predictor of RCAVF maturation (odds ratio, 3.672; 95% confidence interval, 1.394-9.673; P = .008), which was more easily achieved in nondiabetic patients. During the mean follow-up of 47.2 ± 23.1 months, primary patency of RCAVFs was 80.3% at 1 year and 76.5% at 2 years. A Cox proportional hazard model showed diabetes was the only independent risk factor of primary patency (hazard ratio, 2.008; 95% confidence interval, 1.022-3.945; P = .043). Nondiabetic patients with a CV diameter >2 mm had significantly higher primary maturation rate and higher primary patency than diabetic patients with a CV diameter ≤2 mm. CONCLUSIONS: There were different risk factors affecting RCAVF primary maturation and primary patency. A CV with a small-diameter of ≤2 mm combined with diabetes was an independent risk factor of failure not only of primary maturation but also of primary patency in RCAVF.
OBJECTIVE: This study identified predictors affecting maturation and patency of autogenous radiocephalic arteriovenous fistulas (RCAVFs). METHODS: We retrospectively reviewed the prospectively collected clinical data of all patients who underwent primary RCAVF creation and evaluated the effect of clinical variables and findings of preoperative duplex ultrasound mapping on primary maturation and patency rates of RCAVFs. RESULTS: From August 2008 to December 2010, 383 vascular access procedures were performed in 371 patients; of these, 331 (86.4%) were autogenous AVFs, 283 (85.5%) were primary first AVFs, and 186 (65.7%) of these were RCAVFs. The primary maturation rate was 88.2% at a mean of 39 ± 24.1 days after the operation. By multiple logistic regression analysis, minimum cephalic vein (CV) diameter >2 mm was an independent predictor of RCAVF maturation (odds ratio, 3.672; 95% confidence interval, 1.394-9.673; P = .008), which was more easily achieved in nondiabeticpatients. During the mean follow-up of 47.2 ± 23.1 months, primary patency of RCAVFs was 80.3% at 1 year and 76.5% at 2 years. A Cox proportional hazard model showed diabetes was the only independent risk factor of primary patency (hazard ratio, 2.008; 95% confidence interval, 1.022-3.945; P = .043). Nondiabeticpatients with a CV diameter >2 mm had significantly higher primary maturation rate and higher primary patency than diabeticpatients with a CV diameter ≤2 mm. CONCLUSIONS: There were different risk factors affecting RCAVF primary maturation and primary patency. A CV with a small-diameter of ≤2 mm combined with diabetes was an independent risk factor of failure not only of primary maturation but also of primary patency in RCAVF.
Authors: Annika Johnson; Grace Cupp; Nicholas Armour; Kyle Warren; Christopher Stone; Davin Lee; Nicholas Gilbert; Chris Hammond; John Moore; Youngbok Abraham Kang Journal: Front Med Technol Date: 2021-10-28