Intra-operative factors predicting 1-month arteriovenous fistula thrombosis.
OBJECTIVE
The aim of this study is to determine clinical and ultrasound intra-operative factors related to 1-month autogenous arteriovenous fistula (AVF) thrombosis in end-stage renal failure patients.


METHODS
A prospective study was designed, including AVF performed between October 2009 and May 2010. Patient characteristics and intra-operative measurements (clinical and ultrasound findings in both artery and vein: diameters, peak-systolic, end-diastolic and mean velocities, flow and resistance index) were recorded. At 1-month follow-up, AVF primary patency was analyzed. Stepwise logistic regression and ROC curves of the resulting test were used.


RESULTS
111 autogenous end-to-side AVF (44 radiocephalic, 45 brachiocephalic, 22 brachiobasilic) in 101 patients were performed. One-month primary patency rate was 84.7%. Intra-operative absence of bruit following skin closure could predict 1-month AVF thrombosis (70.6% sensitivity and 80.9% specificity, better than absence of thrill: 35.3% and 87.2%). However, logistic regression identified intra-operative end-diastolic velocity in the proximal feeding artery after AVF creation (EDV) as the best independent predictor of 1-month AVF thrombosis (OR=1.072, 95%CI 1.036-1.109; 76.5% sensitivity and 84.0% specificity for EDV<24.5 cm/s). This is a slight improvement on isolated clinical findings, but nevertheless a low positive predictive value (46.4%) is attained.


CONCLUSIONS
Prediction of AVF thrombosis with intra-operative ultrasound measurements (proximal artery EDV under 24.5 cm/s) can slightly improve isolated clinical findings, helping to establish an intra-operative criterion to review AVF and increase surgical efficiency, assuming a relatively low positive predictive value.
Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain. gasparmestres@gmail.com
Gaspar
G
Mestres
Nestor
N
Fontseré
Cesar
C
García-Madrid
Paula
P
Campelos
Francisco
F
Maduell
Vicente
V
Riambau
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012039:Regional Blood Flow; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018617:Ultrasonography, Doppler, Pulsed; D014654:Vascular Patency; D014655:Vascular Resistance