Long-term patency of arteriovenous fistulas for hemodialysis: A decade's experience in a transplant unit

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY Hemodialysis International Pub Date : 2023-08-06 DOI:10.1111/hdi.13110

Matthias Pfister, Lorenzo Viggiani d'Avalos, Philip C. Müller, Olivier de Rougemont, Marco Bonani, Adrian Kobe, Gilbert Puippe, Felix Nickel, Fabian Rössler

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引用次数: 1

Abstract

Background

The heterogeneous quality of studies on arteriovenous fistulas outcome, with variable clinical settings and large variations in definitions of patency and failure rates, leads to frequent misinterpretations and overestimation of arteriovenous fistula patency. Hence, this study aimed to provide realistic and clinically relevant long-term arteriovenous fistula outcomes.

Methods

We retrospectively analyzed all autologous arteriovenous fistulas at our center over a 10-year period (2012–2022). Primary and secondary patency analysis was conducted using the Kaplan–Meier method; multivariate analysis of variance was used to detect outcome predictors. Vascular access-specific endpoints were defined according to the European guidelines on vascular access formation.

Findings

Of 312 arteriovenous fistulas, 57.5% (n = 181) were radio-cephalic (RC_AVF), 35.2% (n = 111) brachio-cephalic (BC_AVF), and 6.3% (n = 20) brachio-basilic (BB_AVF). 6, 12, and 24 months follow-up was available in 290 (92.1%), 282 (89.5%), and 259 (82.2%) patients, respectively. Primary patency rates at 6, 12, and 24 months were 39.5%, 34.8%, and 27.2% for RC_AVF, 58.3%, 44.4%, and 27.8% for BC_AVF, and 40.0%, 42.1%, and 22.2% for BB_AVF (p = 0.15). Secondary patency rates at 6, 12, and 24 months were 65.7%, 63.8%, and 59.0% for RC_AVF, 77.7%, 72.0%, and 59.6% for BC_AVF, and 65.0%, 68.4%, and 61.1% for BB_AVF (p = 0.29). Factors associated with lower primary and secondary patency were hemodialysis at time of arteriovenous fistula formation (p = 0.037 and p = 0.024, respectively) and higher Charlson Comorbidity Index (p = 0.036 and p < 0.001, respectively). Previous kidney transplant showed inferior primary patency (p = 0.005); higher age inferior secondary patency (p < 0.001).

Discussion

Vascular access care remains challenging and salvage interventions are often needed to achieve maturation or maintain patency. Strict adherence to standardized outcome reporting in vascular access surgery paints a more realistic picture of arteriovenous fistula patency and enables reliable intercenter comparison.

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用于血液透析的动静脉瘘的长期通畅性：在移植病房的十年经验。

背景：动静脉瘘研究结果的质量参差不齐，临床环境多变，通畅率和失败率的定义差异很大，导致对动静脉瘘通畅性的频繁误解和高估。因此，本研究旨在提供现实和临床相关的长期动静脉瘘结果。方法：我们回顾性分析了我们中心10年来（2012-2022）的所有自体动静脉瘘。采用Kaplan-Meier方法进行一次和二次通畅性分析；多变量方差分析用于检测结果预测因素。根据欧洲血管通路形成指南定义了血管通路特异性终点。结果：312例动静脉瘘中，57.5%（n = 181）为放射性脑脊髓炎（RC_AVF），35.2%（n = 111）和6.3%（n = 20）腕骨-基底纤维（BB_AVF）。6、12和24 290例（92.1%）、282例（89.5%）和259例（82.2%）患者分别进行了月随访。6岁、12岁和24岁时的初次通畅率 RC_AVF的月数分别为39.5%、34.8%和27.2%，BC_AVF为58.3%、44.4%和27.8%，BB_AVF分别为40.0%、42.1%和22.2%（p = 0.15）。6、12和24时的二次通畅率 RC_AVF的月数分别为65.7%、63.8%和59.0%，BC_AVF为77.7%、72.0%和59.6%，BB_AVF分别为65.0%、68.4%和61.1%（p = 0.29）。与一次和二次通畅率较低相关的因素是动静脉瘘形成时的血液透析（p = 0.037和p = 0.024）和较高的Charlson合并症指数（p = 0.036和p 讨论：血管通路护理仍然具有挑战性，通常需要抢救性干预措施来实现成熟或保持通畅。严格遵守血管通路手术的标准化结果报告，可以更真实地描述动静脉瘘的通畅性，并能够进行可靠的中心间比较。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.

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