title: Risk factors predicting the successful function and use of autogenous arteriovenous fistulae for hemodialysis.
abstract: BACKGROUND
  For patients with end-stage renal failure hemodialysis with an autogenous arteriovenous fistula (AVF) has proven to be the ideal vascular access.
  
  
  OBJECTIVE
  The aim of this study is to discover potential predictors of a well-functioning hemodialysis fistula.
  
  
  METHODS
  From December 2009 to March 2011, 80 patients undergoing first time AVF creation were enrolled in our retrospective study. We analyzed pre- and postoperative vessel diameters and flow characteristics gained by duplex ultrasonography (DUS) and intraoperative ultrasound transit-time flow measurements regarding intraoperative blood flow and pulsatility index (PI). Follow-up was defined until the end of the first month with regular hemodialysis, 10 weeks after AVF creation. We performed statistical analyses by employing Spearman correlation, t test, analysis of variance, χ2 test, and receiver operating characteristics (ROC).
  
  
  RESULTS
  At the end of the follow-up, 62 patients (78%) featured functioning AVFs and 18 patients (22%) featured nonfunctioning AVFs. Factors influencing AVF function were radial artery diameter (χ2 = 5.23, p = 0.02), intraoperative flow (χ2 = 7.09, p = 0.01), intraoperative PI (χ2 = 6.5, p = 0.01), and postoperative flow (χ2 = 16.29, p = 0.01). According to the ROC analyses, we could develop cut-off values for predicting an ideal AVF function: radial artery diameter more than 2.3 mm, cephalic vein diameter more than 2.7 mm, intraoperative mean flow more than 113 mL/min, PI less than 1.4, and postoperative mean flow more than 160 mL/min.
  
  
  CONCLUSIONS
  Intraoperative ultrasound transit-time flow measurements gained at surgery and postoperative follow-up with DUS can help identify AVFs that are unlikely to function and therefore need early intervention.
authors.affiliation: Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany. engin.usta@gmx.de
authors.forename: Engin
authors.initials: E
authors.lastname: Usta
authors.forename: Raoof
authors.initials: R
authors.lastname: Elkrinawi
authors.forename: Shahriar
authors.initials: S
authors.lastname: Salehi-Gilani
authors.forename: Sara
authors.initials: S
authors.lastname: Adili
authors.forename: Thorsten
authors.initials: T
authors.lastname: Sonnentag
authors.forename: Mark
authors.initials: M
authors.lastname: Alscher
authors.forename: Ferruh
authors.initials: F
authors.lastname: Artunc
authors.forename: Ulrich
authors.initials: U
authors.lastname: Franke
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001783:Blood Flow Velocity; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011673:Pulsatile Flow; D012372:ROC Curve; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency