Abstract: SA-PO950
A Novel Prospective in Maturation of Native Arteriovenous Fistula (AVF): Preliminary Data from a Single Center
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Giannikouris, Ioannis Emmanouel, Medifil SA, Athens, Greece
- Koutis, Ioannis, Thriasio General Hospital of Elefsina, Elefsina, Greece
- Kyriazis, Periklis Panos, Baystate Medical Center/University of Massachusetts, Springfield, Massachusetts, United States
- Mikros, Sotiris, General Hospital of Piraeus, Athens, Greece
- Giordano, Giovanni, Vanvitelli L. Hospital, Tramonti, Italy
- Bacchini, Giuseppe, Alessandro Manzoni Hospital Lecco, Lecco, Lombardy, Italy
Background
Our objective was to quantitatively evaluate time alterations of parameters, predictive of hemodynamic maturation of the newly created AVF, in the immediate and late postoperative period (60 days).
Methods
Observational prospective cohort study of 80 incident hemodialysis (HD) and non-dialysis dependent end-stage renal disease (ESRD) patients, who were referred to for AVF creation. Measured parameters predictive of AVF hemodynamic maturation were; lumen diameter of feeding artery (brachial artery, dBA), efferent vein lumen diameter (dEV) and wall thickness (tEV), access volume flow rate (VF) and brachial artery resistive index (RI). Measurements were conducted daily from postoperative day 1 to 7, days 14, 21, 28 and day 60 from AVF creation (day 0). Daily average alteration value of each parameter was assessed and comparison of average observed values followed.
Results
A total of 80 patients, 63 males and 17 females aged 62±15 years, 48 on HD and 32 with non-dialysis dependent ESRD, were enrolled. Fistulae of 4 patients failed during the study period (5% primary failure rate). In total, 43 distal and 33 proximal AVF were successfully created and studied upon completion of follow-up. A daily increase of 0.71% in dBA and 0.70% in dEV from day 1 to 7 was observed. Daily increment rate of dBA and dEV, from day 8 to 28, was calculated at 0.07% and 0.06%, respectively, whereas from day 29 to 60 dBA was daily increased by 0.01% and dEV by 0.01%. Regarding tEV, a daily increase by 2.75% from day 1 to 7, 0.08% (days 8 to 28) and 0.01% daily from day 29 to 60 was observed. Resistive Index RI was decreased by 1.33% (days 1 to 7), 0.10% from day 8 to 28, while from day 29 to 60 it was increased by 0.03%. Lastly, VF was increased daily by 1.79% (day 1 to 7), while increase rate was calculated at 0.01% (day 8 to 28) and 0.004% from day 29 to 60.
Conclusion
Hemodynamic maturation of a newly created AVF is thought to be concluded in the first postoperative week. These findings may offer a new perspective to determine the optimal time to assess the hemodynamic and clinical maturation of AVF but most importantly contribute on decisions making about time of interventions to assist maturation. However, future research is considered mandatory for establishment of firm conclusions.