TY - GEN
T1 - Distal arteriovenous fistula (AVF) failure: risk factors
AU - Abdulnabi, K
AU - Lyon, P
AU - Denham, Nathan
AU - Khalil, A
AU - Howse, M
AU - Anijeet, H
AU - Rylands, I
AU - Alexander, J
AU - Pai, P
AU - Powell, S
AU - Ridway, D
N1 - https://britishrenal.org/ukkw2018-2/2016-abstracts/
PY - 2014
Y1 - 2014
N2 - OBJECTIVE:
(NICE) and (KDIGO) still recommend that distal AVF creation should be attempted first before attempting more proximal. It is reported that fistulae using radial arteries with diameters smaller than 1.5 mm were unlikely to be usable for dialysis. It was proposed that a minimal arterial diameter threshold of 2.0 mm is required for fistula construction.The aim of this retrospective sub analysis of distal AVF is to study risk factors associated with AVF failure.
METHODS: Retrospective data analysis on 64 distal AVF was performed on prevalent haemodialysis patients undertaken at a tertiary renal centre.
RESULTS: Age is 60±17 ( 25-90), male: female = 2: 1
Brachial ,Radial artery size and flow on venous mapping prior to AVF formation
FAILED
AVF N Mean Std. Deviation p
(B)Arterial flow on venous mapping ml/min No 13 73.15 41.06 0.7
Yes 16 48.69 23.09
(R)Arterial flow on venous mapping ml/min No 12 8.42 3.34 0.37
Yes 12 7.33 2.31
(B)Arterial diameter on venous mapping, mm No 33 4.74 0.93 0.002
Yes 24 3.94 0.89
distal (R)Arterial diameter on venous mapping, mm No 37 2.45 0.58 0.004
Yes 27 2.02 0.54
There is significant correlation between radial artery size and AVF failure (p<0.001).
Radial artery calibre <2.2mm, on pre op venous mapping, is associated with cumulative AVF failure of (58%), primary failure at 3 months of (48%) and at 1 year of (52%) compared to 27%, 21% and 27% for calibre ≥2.2. Immaturity was the cause of failure in 67%; p<0.05, OR= 3 (1-10).
Assisted 3 month distal AVF primary failure in patients with PMH of AVF failure was 80% (12/15), compared to only 20% (10/49) in those with no previous fistulae failure; p=0.00005,OR=16 (4 -66).
Multivariate analysis shows that Radial artery size (p<0.02), Brachial artery size (p<0.03) to be associated with forearm AVF failure. Hypercoagulable state (p=0.007) Female gender (p=0.03) and Aspirin 75mg (0.04) and PMH of fistula failure (p=0.04) were associated with 3 month primary failure. (OR= 42, 1.6, 9.9, 2.3 respectively)
Warfarinisation, PVD, HTN, heart failure, Diabetes or CVA didn’t show any statistical significance.
CONCLUSION:
Forearm AV fistulae should be avoided in patients with radial artery of less than 2,2mm.especially in the presence of hypercogulable state and past history of AVF failure. Pharmacological therapy plays no role in reducing distal AVF failure.
AB - OBJECTIVE:
(NICE) and (KDIGO) still recommend that distal AVF creation should be attempted first before attempting more proximal. It is reported that fistulae using radial arteries with diameters smaller than 1.5 mm were unlikely to be usable for dialysis. It was proposed that a minimal arterial diameter threshold of 2.0 mm is required for fistula construction.The aim of this retrospective sub analysis of distal AVF is to study risk factors associated with AVF failure.
METHODS: Retrospective data analysis on 64 distal AVF was performed on prevalent haemodialysis patients undertaken at a tertiary renal centre.
RESULTS: Age is 60±17 ( 25-90), male: female = 2: 1
Brachial ,Radial artery size and flow on venous mapping prior to AVF formation
FAILED
AVF N Mean Std. Deviation p
(B)Arterial flow on venous mapping ml/min No 13 73.15 41.06 0.7
Yes 16 48.69 23.09
(R)Arterial flow on venous mapping ml/min No 12 8.42 3.34 0.37
Yes 12 7.33 2.31
(B)Arterial diameter on venous mapping, mm No 33 4.74 0.93 0.002
Yes 24 3.94 0.89
distal (R)Arterial diameter on venous mapping, mm No 37 2.45 0.58 0.004
Yes 27 2.02 0.54
There is significant correlation between radial artery size and AVF failure (p<0.001).
Radial artery calibre <2.2mm, on pre op venous mapping, is associated with cumulative AVF failure of (58%), primary failure at 3 months of (48%) and at 1 year of (52%) compared to 27%, 21% and 27% for calibre ≥2.2. Immaturity was the cause of failure in 67%; p<0.05, OR= 3 (1-10).
Assisted 3 month distal AVF primary failure in patients with PMH of AVF failure was 80% (12/15), compared to only 20% (10/49) in those with no previous fistulae failure; p=0.00005,OR=16 (4 -66).
Multivariate analysis shows that Radial artery size (p<0.02), Brachial artery size (p<0.03) to be associated with forearm AVF failure. Hypercoagulable state (p=0.007) Female gender (p=0.03) and Aspirin 75mg (0.04) and PMH of fistula failure (p=0.04) were associated with 3 month primary failure. (OR= 42, 1.6, 9.9, 2.3 respectively)
Warfarinisation, PVD, HTN, heart failure, Diabetes or CVA didn’t show any statistical significance.
CONCLUSION:
Forearm AV fistulae should be avoided in patients with radial artery of less than 2,2mm.especially in the presence of hypercogulable state and past history of AVF failure. Pharmacological therapy plays no role in reducing distal AVF failure.
M3 - Conference contribution
BT - British Renal Society 2014 Conference Abstracts
ER -