title: Outcomes of arteriovenous fistulae created by a U.S. interventional nephrologist.
abstract: Arteriovenous fistulae (AVF) outcomes in the United States continue to fall short of expectations and continue to compare disfavorably to European AVF outcomes. This study presents the early experience of nephrologist created AVF outcomes in the U.S. hemodialysis population. A retrospective analysis of a prospectively collected vascular access database was performed. All patients who were referred for vascular access placement over a 1-year period were eligible for inclusion. One hundred five (n = 105) patients were initially included in the database. An AVF was placed in 100% of patients referred for vascular access. Two complications were identified (one steal syndrome and one infection) for a rate of 1.9%. The patient demographics included 38.7% female, age 63.6 + or - 14.8, 50.0% diabetic, 66.0% hypertensive, with 65.1% of patients in stage 5 chronic kidney disease at the time of AVF placement. Average target artery diameter was 4.09 + or - 1.16 mm while average target vein diameter was 3.66 + or - 1.20. Twenty-one AVF were placed in the forearm (19.8%) with the remainder being placed in the upper arm vessels. Eighteen patients (18.56%) failed to mature at 6 weeks. Sixty-four patients (65.98%) required revision or intervention of their AVF between 12 weeks postoperatively and the endpoint of the study. Eighty patients (84.21%) had patent AVF at an average follow-up of 286.2 + or - 98.14 days. No identifiable risk factors among those listed above were associated with a significant impact on AVF outcomes. AVF outcomes that compare favorably to those of Europe can be achieved by U.S. interventional nephrologists. Furthermore, the dictum that distal is better needs to be re-examined if the United States hopes to achieve the goal of 66% AVF prevalence.
authors.affiliation: AKDHC Ambulatory Surgery Center, Phoenix, Arizona, USA.
authors.forename: Rick
authors.initials: R
authors.lastname: Mishler
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
mesh_terms: D000553:Ambulatory Care; D001130:Arizona; D001132:Arm / Q000098:blood supply* / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001808:Blood Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D014654:Vascular Patency