Vein Histology in Arteriovenous Fistulas and Its Effect on Fistula Surgery Success
A Cohort Study of the Histopathological Changes Evident in Vein Wall at the Time of Arteriovenous Dialysis Access Fistulas and the Effects of Such Changes on Biomechanical Compliance and Patient's Clinical Outcomes in a University Teaching Hospital.
Patients whose kidneys have failed need to receive dialysis treatment, most commonly with a dialysis machine. In order to be connected to the machine an operation is often performed to join an artery to a vein in the arm. This forms what is known as an arteriovenous fistula. The fistula causes an increase in the flow of blood through the vein and the vein reacts to this by becoming bigger and thicker, making it easier to connect the patient to the machine.
The success rate for the operation is relatively low and only approximately 65 from every 100 operations is still working after a year. It is thought that one factor that may cause problems with the fistula is the ability of the vein to stretch in response to increased blood flow. Previous research has shown that veins in kidney failure patients look different to those of people whose kidneys are working when viewed under a microscope.
The investigators aim to study the structure of the vein that is used in making fistulas with a microscope and also to test it in an engineering laboratory to see how much it will stretch. The investigators hope that gaining information about the structure of the vein and its ability to stretch will help determine what it is about the vein that affects how well it works as part of a fistula. This information may help surgeons select the best possible vein in a given patient to give the best chance of a working fistula in the future.
Descripción general del estudio
Estado
Condiciones
Tipo de estudio
Inscripción (Actual)
Contactos y Ubicaciones
Ubicaciones de estudio
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Yorkshire
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Hull, Yorkshire, Reino Unido, HU3 2JZ
- Academic Vascular Surgery Unit
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Método de muestreo
Población de estudio
Descripción
Inclusion Criteria:
- Patients referred to vascular consultants for AV fistula formation for haemodialysis access.
- Ability to give informed written consent
- Aged over 18 at time of referral
Exclusion Criteria:
- Veins identified on preoperative ultrasound scanning to be of a calibre too small to allow sufficient material to be obtained for biomechanical testing (<3mm diameter).
- Inability to give informed written consent
- Aged under 18 at time of referral
- Inability to attend follow-up appointments
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
Cohortes e Intervenciones
Grupo / Cohorte |
|---|
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Observed cohort
All patients recruited.
Observed for clinical outcomes
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Primary failure of access - Immediate/early thrombosis or failure to mature.
Periodo de tiempo: within 30 days of formation
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Failure to mature or thrombosis of fistula
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within 30 days of formation
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Medidas de resultado secundarias
Medida de resultado |
Periodo de tiempo |
|---|---|
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Duplex findings of evidence of stenosis and correlation to compliance or histological findings
Periodo de tiempo: 6 months
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6 months
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Correlation between biomechanical compliance and histological measures of pre existing venous pathology
Periodo de tiempo: 6 months
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6 months
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Correlation between biomechanical compliance testing and clinical outcomes
Periodo de tiempo: 6 months
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6 months
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Assisted primary and secondary patency rates at 3 and 6 months post fistula formation
Periodo de tiempo: 6 months
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6 months
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Functional primary patency
Periodo de tiempo: 6 months
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6 months
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Ian C Chetter, MBChB FRCS, University of Hull
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- Access 4
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