title: Decreased cumulative access survival in arteriovenous fistulas requiring interventions to promote maturation.
abstract: OBJECTIVE
  New arteriovenous fistulas (AVF) are frequently unsuitable for hemodialysis because of AVF nonmaturation. Aggressive endovascular or surgical interventions are often undertaken to salvage nonmaturing AVFs. The effect of early interventions to promote AVF maturation on subsequent long-term AVF outcomes is unknown.
  
  
  METHODS
  We evaluated 173 hemodialysis patients from two academic centers who received a new AVF. Of these, 96 (56%) required no further intervention, 54 (31%) required one intervention, and 23 (13%) required two or more interventions to achieve suitability for dialysis. We calculated AVF survival and frequency of postmaturation interventions in each group.
  
  
  RESULTS
  Cumulative AVF survival (access cannulation to permanent failure) in patients with two or more versus one versus zero interventions before maturation was 68% versus 78% versus 92% at 1 year, 57% versus 71% versus 85% at 2 years, and 42% versus 57% versus 75% at 3 years. Using Cox regression analysis with interventions before maturation, age, sex, race, diabetes, peripheral vascular disease, access site, and obesity in the model, intervention before maturation (two or more) was the only factor associated with cumulative AVF survival. The number of interventions required to maintain patency after maturation was 3.51 ± 2.20 versus 1.37 ± 0.31 versus 0.76 ± 0.10 per year in patients with two or more versus one versus zero interventions before maturation.
  
  
  CONCLUSIONS
  Compared with AVF that mature without interventions, AVF that require interventions have decreased cumulative survival and require more interventions to maintain their patency for hemodialysis.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH 45267-0585, USA. timmy.lee@uc.edu
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
authors.forename: Ahsan
authors.initials: A
authors.lastname: Ullah
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
authors.forename: Paul
authors.initials: P
authors.lastname: Succop
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Khatib
authors.forename: Rino
authors.initials: R
authors.lastname: Munda
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
mesh_terms: D000368:Aged; D000407:Alabama; D000704:Analysis of Variance; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D057510:Endovascular Procedures; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009820:Ohio; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency