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. 2018 Sep 7;13(9):1364-1372.
doi: 10.2215/CJN.02230218. Epub 2018 Aug 23.

Postoperative Ultrasound, Unassisted Maturation, and Subsequent Primary Patency of Arteriovenous Fistulas

Crystal A Farrington  1 , Michelle L Robbin  2 , Timmy Lee  1   3 , Jill Barker-Finkel  4 , Michael Allon  1
Affiliations

Postoperative Ultrasound, Unassisted Maturation, and Subsequent Primary Patency of Arteriovenous Fistulas

Crystal A Farrington et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Postoperative ultrasound is commonly used to assess arteriovenous fistula (AVF) maturation for hemodialysis, but its utility for predicting unassisted AVF maturation or primary AVF patency for hemodialysis has not been well defined. This study assessed the predictive value of postoperative AVF ultrasound measurements for these clinical AVF outcomes.

Design, setting, participants, & measurements: We queried a prospective vascular access database to identify 246 patients on catheter-dependent hemodialysis who underwent AVF creation between 2010 and 2016 and obtained a postoperative ultrasound within 90 days. Multivariable logistic regression was used to evaluate the association of clinical characteristics and postoperative ultrasound measurements with unassisted AVF maturation. A receiver operating characteristic curve estimated the predictive value of these factors for unassisted AVF maturation. Finally, multivariable survival analysis was used to identify factors associated with primary AVF patency in patients with unassisted AVF maturation.

Results: Unassisted AVF maturation occurred in 121 out of 246 patients (49%), assisted maturation in 55 patients (22%), and failure to mature in 70 patients (28%). Using multivariable logistic regression, unassisted AVF maturation was associated with AVF blood flow (odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.18 to 1.45 per 100 ml/min increase; P<0.001), forearm location (OR, 0.37; 95% CI, 0.08 to 1.78; P=0.21), presence of stenosis (OR, 0.45; 95% CI, 0.23 to 0.88; P=0.02); AVF depth (OR, 0.88; 95% CI, 0.77 to 1.00 per 1 mm increase; P=0.05), and AVF location interaction with depth (OR, 0.50; 95% CI, 0.28 to 0.84; P=0.02). The area under the receiver operating characteristic curve, using all these factors, was 0.84 (95% CI, 0.79 to 0.89; P<0.001). Primary AVF patency in patients with unassisted maturation was associated only with AVF diameter (hazard ratio, 0.84; 95% CI, 0.76 to 0.94 per 1 mm increase; P=0.002).

Conclusions: Unassisted AVF maturation is predicted by AVF blood flow, location, depth, and stenosis. AVF patency after unassisted maturation is predicted only by the postoperative AVF diameter.

Keywords: Constriction, Pathologic; Forearm; Humans, ROC Curve; Logistic Models; Prospective Studies; Survival Analysis; arteriovenous fistula; hemodialysis access; renal dialysis; vascular access.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Patient inclusion and exclusion criteria. CVC, central venous catheter; US, ultrasound.
Figure 2.
Figure 2.
Progressive increases in AVF blood flow are associated with higher rates of unassisted AVF maturation for multiple subgroups. However, at any given blood flow, forearm location, stenosis, and greater depth were each associated with a decreased likelihood of unassisted AVF maturation. Qb, AVF blood flow.
Figure 3.
Figure 3.
ROC curve showing that unassisted AVF maturation is predicted by postoperative blood flow, AVF depth, AVF location, and postoperative stenosis. loc, location.
Figure 4.
Figure 4.
Larger postoperative diameter is associated with greater primary AVF patency after unassisted maturation. Diam, diameter.
See this image and copyright information in PMC

Comment in

  • Determinants of Arteriovenous Fistula Maturation.
    Hentschel DM. Hentschel DM. Clin J Am Soc Nephrol. 2018 Sep 7;13(9):1307-1308. doi: 10.2215/CJN.08860718. Epub 2018 Aug 23. Clin J Am Soc Nephrol. 2018. PMID: 30139805 Free PMC article. No abstract available.

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