Thorac Cardiovasc Surg 2013; 61(05): 438-444
DOI: 10.1055/s-0032-1321953
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Risk Factors Predicting the Successful Function and Use of Autogenous Arteriovenous Fistulae for Hemodialysis

Engin Usta
1   Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
,
Raoof Elkrinawi
1   Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
,
Shahriar Salehi-Gilani
1   Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
,
Sara Adili
1   Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
,
Thorsten Sonnentag
2   Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert Bosch Hospital, Stuttgart, Germany
,
Mark Alscher
2   Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert Bosch Hospital, Stuttgart, Germany
,
Ferruh Artunc
3   Section of Nephrology and Hypertension, Department of Internal Medicine IV, Tübingen University Hospital, Tübingen, Germany
,
Ulrich Franke
1   Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
› Author Affiliations
Further Information

Publication History

26 February 2012

11 April 2012

Publication Date:
20 November 2012 (online)

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Abstract

Background For patients with end-stage renal failure hemodialysis with an autogenous arteriovenous fistula (AVF) has proven to be the ideal vascular access.

Objective The aim of this study is to discover potential predictors of a well-functioning hemodialysis fistula.

Methods From December 2009 to March 2011, 80 patients undergoing first time AVF creation were enrolled in our retrospective study. We analyzed pre- and postoperative vessel diameters and flow characteristics gained by duplex ultrasonography (DUS) and intraoperative ultrasound transit-time flow measurements regarding intraoperative blood flow and pulsatility index (PI). Follow-up was defined until the end of the first month with regular hemodialysis, 10 weeks after AVF creation. We performed statistical analyses by employing Spearman correlation, t test, analysis of variance, χ2 test, and receiver operating characteristics (ROC).

Results At the end of the follow-up, 62 patients (78%) featured functioning AVFs and 18 patients (22%) featured nonfunctioning AVFs. Factors influencing AVF function were radial artery diameter (χ2 = 5.23, p = 0.02), intraoperative flow (χ2 = 7.09, p = 0.01), intraoperative PI (χ2 = 6.5, p = 0.01), and postoperative flow (χ2 = 16.29, p = 0.01). According to the ROC analyses, we could develop cut-off values for predicting an ideal AVF function: radial artery diameter more than 2.3 mm, cephalic vein diameter more than 2.7 mm, intraoperative mean flow more than 113 mL/min, PI less than 1.4, and postoperative mean flow more than 160 mL/min.

Conclusion Intraoperative ultrasound transit-time flow measurements gained at surgery and postoperative follow-up with DUS can help identify AVFs that are unlikely to function and therefore need early intervention.