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  • Title: Arteriovenous Fistula Development in the First 6 Weeks after Creation.
    Author: Robbin ML, Greene T, Cheung AK, Allon M, Berceli SA, Kaufman JS, Allen M, Imrey PB, Radeva MK, Shiu YT, Umphrey HR, Young CJ, Hemodialysis Fistula Maturation Study GroupFrom the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)..
    Journal: Radiology; 2016 May; 279(2):620-9. PubMed ID: 26694050.
    Abstract:
    PURPOSE: To assess the anatomic development of native arteriovenous fistula (AVF) during the first 6 weeks after creation by using ultrasonographic (US) measurements in a multicenter hemodialysis fistula maturation study. MATERIALS AND METHODS: Each institutional review board approved the prospective study protocol, and written informed consent was obtained. Six hundred and two participants (180 women and 422 men, 459 with upper-arm AVF and 143 with forearm AVF) from seven clinical centers underwent preoperative artery and vein US mapping. AVF draining vein diameter and blood flow rate were assessed postoperatively after 1 day, 2 weeks, and 6 weeks. Relationships among US measurements were summarized after using multiple imputation for missing measurements. RESULTS: In 55% of forearm AVFs (68 of 124) and 83% of upper-arm AVFs (341 of 411) in surviving patients without thrombosis or AVF intervention prior to 6 weeks, at least 50% of their 6-week blood flow rate measurement was achieved at 1 day. Among surviving patients without thrombosis or AVF intervention prior to week 2, 70% with upper-arm AVFs (302 of 433) and 77% with forearm AVFs (99 of 128) maintained at least 85% of their week 2 flow rate at week 6. Mean AVF diameters of at least 0.40 cm were seen in 85% (389 of 459), 91% (419 of 459), and 87% (401 of 459) of upper-arm AVFs and in 40% (58 of 143), 73% (104 of 143), and 77% (110 of 143) of forearm AVFs at 1 day, 2 weeks, and 6 weeks, respectively. One-day and 2-week AVF flow rates and diameters were used to predict 6-week levels, with 2-week prediction of 6-week measures more accurate than those of 1 day (flow rates, R(2) = 0.47 and 0.61, respectively; diameters, R(2) = 0.49 and 0.82, respectively). CONCLUSION: AVF blood flow rate at 1 day is usually more than 50% of the 6-week blood flow rate. Two-week measurements are more predictive of 6-week diameter and blood flow than those of 1 day. US measurements at 2 weeks may be of value in the early identification of fistulas that are unlikely to develop optimally.
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