No difference of arteriovenous fistula successful creation and maturation between diabetic and non-diabetic patients after three months of surgery: The beneficial role of preoperative doppler ultrasound.
Journal
Nephrology Dialysis Transplantation
Date Issued
2019
Author(s)
Dzekova-Vidmliski, Pavlina
Sikole, Aleksandar
Ivanovski, Ninoslav
Abstract
INTRODUCTION: The arteriovenous fistula (AVF) has become a symbol of
hemodyalisis (HD) which guarantees the successful treatment and allows a multidecade
survival of patients. However the AVF creation and maturation is still a
significant medical challenge especially in diabetic patients (DP). Due to the peripheral
diabetic vasculopathy the rate of fistula failure of DP is still higher than the nondiabetic
patients (NDP). The aim of the study was to compare the outcomes of DP and
NDP with chronic kidney disease ( CKD) stage 5 undergoing creation of a new upper
limb AVF using a preoperative vessels mapping by Doppler ultrasound.
METHODS: Medical records for creation of AVF in the patients with CKD stage 5 for
year 2018 were analyzed in a single center. Preoperative Doppler ultrasound for
assessing the adequacy of blood vessels and to determine the location of AVF creation,
were performed in all patients, a vein diameter > 2mmand an artery diameter _ 1.6
mmare considered adequate. Three different types of AVF were created: the distal
(radial-cephalic), middle-arm (radial-cephalic) and proximal (brachial-cephalic).
Primary thrombosis of AVF was defined as an immediate failure of fistula within 24
hours of creation and primary failure was defined as thrombosis of fistula within 3
mounts. The demographic variables, location of the AVF creation, and HDtime were
included as parameters for determination of the successful maturation of AVF.
RESULTS: We analyzed 367 created AVF in 238 men (64,85%) and 129 female
(35,15%). The average age of patients was 61.4614.2 years and mean HD vintage was
14 months. Successful AVF was created in 301 patients (82%) while primary
thrombosis occurred in 66 patients (18%) of created fistulas. AVF maturation within 3
months was successful in 272 patients (74,15%), while the primary failure occurred in
95 patients (25,85%) of created fistulas. The distal AVF was dominant location in 168
(47,78%), followed by middle-arm location in 136 (37,06%) and proximal in 63
(17,16%) of created fistulas. AVF was created in 104 (28,3%) DP and 263 (71,7%)
NDP. The DP were significantly older than NDP (64,12 vs. 60,40 years, p=0.000), and
with shorter HD vintage in DP compared to NDP (7,06 vs. 16,49 months, p=0.004).
There was no association between successful AVF creation and diabetes mellitus
(OR=1,0, 95%CI 0,91-1,08, p=0,010). The AVF maturation was also not associated
with diabetes mellitus (OR=1,0, 95%CI 0,93-1,14, p=0,413).
CONCLUSIONS: Using a preoperative Doppler ultrasound in the creation and
maturation of AVF in DP are comparable with NDP regarding primary thrombosis and
fistula failure for a period of three months of follow up. Further analysis are needed for
the assessment of long term AVF functional capacity in both groups of patients
hemodyalisis (HD) which guarantees the successful treatment and allows a multidecade
survival of patients. However the AVF creation and maturation is still a
significant medical challenge especially in diabetic patients (DP). Due to the peripheral
diabetic vasculopathy the rate of fistula failure of DP is still higher than the nondiabetic
patients (NDP). The aim of the study was to compare the outcomes of DP and
NDP with chronic kidney disease ( CKD) stage 5 undergoing creation of a new upper
limb AVF using a preoperative vessels mapping by Doppler ultrasound.
METHODS: Medical records for creation of AVF in the patients with CKD stage 5 for
year 2018 were analyzed in a single center. Preoperative Doppler ultrasound for
assessing the adequacy of blood vessels and to determine the location of AVF creation,
were performed in all patients, a vein diameter > 2mmand an artery diameter _ 1.6
mmare considered adequate. Three different types of AVF were created: the distal
(radial-cephalic), middle-arm (radial-cephalic) and proximal (brachial-cephalic).
Primary thrombosis of AVF was defined as an immediate failure of fistula within 24
hours of creation and primary failure was defined as thrombosis of fistula within 3
mounts. The demographic variables, location of the AVF creation, and HDtime were
included as parameters for determination of the successful maturation of AVF.
RESULTS: We analyzed 367 created AVF in 238 men (64,85%) and 129 female
(35,15%). The average age of patients was 61.4614.2 years and mean HD vintage was
14 months. Successful AVF was created in 301 patients (82%) while primary
thrombosis occurred in 66 patients (18%) of created fistulas. AVF maturation within 3
months was successful in 272 patients (74,15%), while the primary failure occurred in
95 patients (25,85%) of created fistulas. The distal AVF was dominant location in 168
(47,78%), followed by middle-arm location in 136 (37,06%) and proximal in 63
(17,16%) of created fistulas. AVF was created in 104 (28,3%) DP and 263 (71,7%)
NDP. The DP were significantly older than NDP (64,12 vs. 60,40 years, p=0.000), and
with shorter HD vintage in DP compared to NDP (7,06 vs. 16,49 months, p=0.004).
There was no association between successful AVF creation and diabetes mellitus
(OR=1,0, 95%CI 0,91-1,08, p=0,010). The AVF maturation was also not associated
with diabetes mellitus (OR=1,0, 95%CI 0,93-1,14, p=0,413).
CONCLUSIONS: Using a preoperative Doppler ultrasound in the creation and
maturation of AVF in DP are comparable with NDP regarding primary thrombosis and
fistula failure for a period of three months of follow up. Further analysis are needed for
the assessment of long term AVF functional capacity in both groups of patients
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