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.

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