Arteriovenous Fistula Development in the First 6 Weeks after Creation
Michelle L Robbin, Tom Greene, Alfred K Cheung, Michael Allon, Scott A Berceli, James S Kaufman, Matthew Allen, Peter B Imrey, Milena K Radeva, Yan-Ting Shiu, Heidi R Umphrey, Carlton J Young, Hemodialysis Fistula Maturation Study Group, H Feldman, L Dember, A Farber, J Kaufman, L Stern, P LeSage, C Kivork, D Soares, M Malikova, M Allon, C Young, M Taylor, L Woodard, K Mangadi, P Roy-Chaudhury, R Munda, T Lee, R Alloway, M El-Khatib, T Canaan, A Pflum, L Thieken, B Campos-Naciff, T Huber, S Berceli, M Jansen, G McCaslin, Y Trahan, M Vazquez, W Vongpatanasin, I Davidson, C Hwang, T Lightfoot, C Livingston, A Valencia, B Dolmatch, A Fenves, N Hawkins, A Cheung, L Kraiss, D Kinikini, G Treiman, D Ihnat, M Sarfati, I Lavasani, M Maloney, L Schlotfeldt, J Himmelfarb, C Buchanan, C Clark, C Crawford, J Hamlett, J Kundzins, L Manahan, J Wise, G Beck, J Gassman, T Greene, P Imrey, L Li, J Alster, M Li, J MacKrell, M Radeva, B Weiss, K Wiggins, C Alpers, K Hudkins, T Wietecha, M Robbin, H Umphrey, L Alexander, C Abts, L Belt, J Vita, N Hamburg, M Duess, A Levit, H Higgins, S Ke, O Mandaci, C Snell, J Gravley, S Behnken, R Mortensen, G Chertow, A Besarab, K Brayman, M Diener-West, D Harrison, L Inker, T Louis, W McClellan, J Rubin, J Kusek, R Star, Michelle L Robbin, Tom Greene, Alfred K Cheung, Michael Allon, Scott A Berceli, James S Kaufman, Matthew Allen, Peter B Imrey, Milena K Radeva, Yan-Ting Shiu, Heidi R Umphrey, Carlton J Young, Hemodialysis Fistula Maturation Study Group, H Feldman, L Dember, A Farber, J Kaufman, L Stern, P LeSage, C Kivork, D Soares, M Malikova, M Allon, C Young, M Taylor, L Woodard, K Mangadi, P Roy-Chaudhury, R Munda, T Lee, R Alloway, M El-Khatib, T Canaan, A Pflum, L Thieken, B Campos-Naciff, T Huber, S Berceli, M Jansen, G McCaslin, Y Trahan, M Vazquez, W Vongpatanasin, I Davidson, C Hwang, T Lightfoot, C Livingston, A Valencia, B Dolmatch, A Fenves, N Hawkins, A Cheung, L Kraiss, D Kinikini, G Treiman, D Ihnat, M Sarfati, I Lavasani, M Maloney, L Schlotfeldt, J Himmelfarb, C Buchanan, C Clark, C Crawford, J Hamlett, J Kundzins, L Manahan, J Wise, G Beck, J Gassman, T Greene, P Imrey, L Li, J Alster, M Li, J MacKrell, M Radeva, B Weiss, K Wiggins, C Alpers, K Hudkins, T Wietecha, M Robbin, H Umphrey, L Alexander, C Abts, L Belt, J Vita, N Hamburg, M Duess, A Levit, H Higgins, S Ke, O Mandaci, C Snell, J Gravley, S Behnken, R Mortensen, G Chertow, A Besarab, K Brayman, M Diener-West, D Harrison, L Inker, T Louis, W McClellan, J Rubin, J Kusek, R Star
Abstract
Purpose: To assess the anatomic development of native arteriovenous fistula (AVF) during the first 6 weeks after creation by using ultrasonographic (US) measurements in a multicenter hemodialysis fistula maturation study.
Materials and methods: Each institutional review board approved the prospective study protocol, and written informed consent was obtained. Six hundred and two participants (180 women and 422 men, 459 with upper-arm AVF and 143 with forearm AVF) from seven clinical centers underwent preoperative artery and vein US mapping. AVF draining vein diameter and blood flow rate were assessed postoperatively after 1 day, 2 weeks, and 6 weeks. Relationships among US measurements were summarized after using multiple imputation for missing measurements.
Results: In 55% of forearm AVFs (68 of 124) and 83% of upper-arm AVFs (341 of 411) in surviving patients without thrombosis or AVF intervention prior to 6 weeks, at least 50% of their 6-week blood flow rate measurement was achieved at 1 day. Among surviving patients without thrombosis or AVF intervention prior to week 2, 70% with upper-arm AVFs (302 of 433) and 77% with forearm AVFs (99 of 128) maintained at least 85% of their week 2 flow rate at week 6. Mean AVF diameters of at least 0.40 cm were seen in 85% (389 of 459), 91% (419 of 459), and 87% (401 of 459) of upper-arm AVFs and in 40% (58 of 143), 73% (104 of 143), and 77% (110 of 143) of forearm AVFs at 1 day, 2 weeks, and 6 weeks, respectively. One-day and 2-week AVF flow rates and diameters were used to predict 6-week levels, with 2-week prediction of 6-week measures more accurate than those of 1 day (flow rates, R(2) = 0.47 and 0.61, respectively; diameters, R(2) = 0.49 and 0.82, respectively).
Conclusion: AVF blood flow rate at 1 day is usually more than 50% of the 6-week blood flow rate. Two-week measurements are more predictive of 6-week diameter and blood flow than those of 1 day. US measurements at 2 weeks may be of value in the early identification of fistulas that are unlikely to develop optimally.
(©) RSNA, 2015 Online supplemental material is available for this article.
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Source: PubMed