Abstract: FR-PO519
Use of Early Ultrasound Scan to Predict Arteriovenous Fistula Maturation
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Zaidi, Syed Shaukat Abbas, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Chan, Cindy, Fresenius Medical Care Asia Pacific Ltd, Hong Kong, Hong Kong
- Wang, Xin, Renal Research Institute, New York, New York, United States
- Cheung, Yan Yi, Clinical Affairs, Global Medical Office, Fresenius Medical Care, Singapore, Singapore
- Grobe, Nadja, Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Mitra, Sandip, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Nikam, Milind, Clinical Affairs, Global Medical Office, Fresenius Medical Care, Singapore, Singapore
Background
The Manchester Vascular Access study (MANVAS) was a prospective observational study which investigated arteriovenous fistula (AVF) maturation. We interrogated the MANVAS data to evaluate whether early doppler ultrasound (DUS) scan could predict AVF maturation.
Methods
Patients undergoing upper limb AVF creation surgery were recruited. In addition to pre-operative vascular mapping, recruited patients had protocolised post-surgery AVF scans, done at weeks 2, 6, 12 after surgery, to assess anatomical and rheological parameters such as blood flow rate and velocities in the index AVF, and the feeding artery. The primary outcome was AVF maturation, which was defined either, as successful haemodialysis using the AVF or a combination of DUS features (vein size > 4 mm with AVF flow ≥ 500 ml/min) and clinical assessment. In this sub-group analysis (where DUS data was available, n=57), we used week 2 post-surgery DUS scan to identify predictors of AVF maturation. We used logistic regression models to explore differences between matured and non-matured groups.
Results
We found that minimal AVF diameter (D-Min), arterial peak systolic velocity (PSV) and end diastolic velocity (EDV), and AVF blood flows (Qa) were significantly higher in matured group compared to non-matured group (Table 1). Of note, the average Qa was almost 2-fold in the group which subsequently had mature AVFs vs the non matured group. After adjusting for age, sex, comorbidities and AVF type, PSV and Qa remained statistically significant.
Conclusion
Vascular flow attributes measured using DUS performed as early as 2 weeks post AVF creation can predict fistula maturation. If validated in a larger cohort, these findings could impact current clinical pathways considering early AVF maturation assessment and intervention.
Logistic Regression Analysis of Week 2 US Scans (n = 57)
| US Parameters | Non matured | Matured | p-Value* |
| D-Min (cm) | 0.31±0.08 | 0.41±0.12 | 0.0739 |
| PSV (cm/sec) | 111.3±52.1 | 189.0±70.7 | 0.0234 |
| EDV (cm/sec) | 47.0±18.9 | 98.3±41.6 | 0.0560 |
| Averaged AVF blood flow (cc/min) | 264.7±152.2 | 494.4±305.7 | 0.0481 |
| Brachial Artery (cc/min) | 378.7±367.6 | 569.9±199.3 | 0.0526 |
*Adjusted for age, sex, race, DM, CVD, and AVF location (i.e. brachial or radial)
Funding
- Commercial Support – Fresenius Medical Care