Results of a Comprehensive Follow-up Program to Enhance Arteriovenous Fistula Maturation

Back to Annual Meeting
Back to Program

Robert B. McLafferty, M.D., Raymond Pryor, B.S., Don E. Ramsey, M.D., Aamir Zakaria, M.D., Colleen Johnson, M.D., Kim J. Hodgson, M.D..
Southern Illinois University, Springfield, IL, USA.

Objective: To determine maturation outcome of native arteriovenous fistulae (AVF) using a comprehensive follow-up and intervention program.
Methods: Consecutive patients undergoing first AVF in a university vascular surgery practice over 5 years were followed every 4 - 6 weeks until a sustainable hemodialysis access (SHDA) of >4 wks was achieved. The vascular surgeon performed regular history and physical exam, selected duplex examination, and coordination of needle access transition. Salvage endovascular and/or operative interventions by the vascular surgeon were performed depending on follow-up findings.
Results: 113 AVFs (58% males, 34% smokers, 58% diabetics, mean age: 60 yrs) were performed of which 96% had preoperative ultrasound vein mapping. Distribution of AVFs included 8 (7%) radiocephalic, 91 (80%) brachiocephalic, and 14 (13%) basilic vein transposition. Of the 113, 74 (65%) had no interventions, 28 (25%) had interventions, and 11 (10%) were deemed early failures (< 6 wks). Interventions included 23 endovascular and 15 operative. In patients having intervention, mean number per patient was 1.43 with 4 patients having two interventions and 3 patients having three interventions. In patients without intervention, 55 (74.3%) achieved SHDA, 8 (10.8%) died prior to maturation, 1 (1.4%) had transplant, and 6 (8.1%) failed. In patients with intervention, 19 (67.8%) achieved SHDA, 1 (3.5%) died prior to maturation, 3 (10.7%) had transplant, and 5 (17.8%) failed. There was no difference in failure rates when comparing AVFs with or without intervention (p=0.16). Although endovascular interventions had better success compared to operative interventions (91% vs. 60%), this was not statistically significant (p = 0.14). All but one or the 7 patients that had multiple interventions reached SHDA.
Conclusions: Although AVF creation is the preferred method to SHDA, continued significant challenges exist in avoiding early failure and increasing maturation. Follow-up by the vascular surgeon until SHDA remains paramount to maximizing maturation for those AVFs at risk for early failure. Given failure in all groups, early fistulagram may be indicated in all patients to guide subsequent treatment.

Back to Annual Meeting
Back to Program