title: Importance of monitoring and treatment of failed maturation in radiocephalic arteriovenous fistula in predialysis: Role of ultrasound.
abstract: The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated.
  
  
  METHODS
  We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow ≥500ml/min and a cephalic vein diameter of ≥4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study.
  
  
  RESULTS
  In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF.
  
  
  CONCLUSIONS
  Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF.
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España. Electronic address: Salomuray@gmail.com.
authors.forename: Salomé
authors.initials: S
authors.lastname: Muray Cases
authors.affiliation: Servicio de Radiología Vascular, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: José
authors.initials: J
authors.lastname: García Medina
authors.affiliation: Servicio de Cirugía, Clínica Mesa del Castillo, Murcia, España.
authors.forename: Juan Mariano
authors.initials: JM
authors.lastname: Pérez Abad
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Alberto Javier
authors.initials: AJ
authors.lastname: Andreu Muñoz
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Ramos Carrasco
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pérez Pérez
authors.affiliation: Servicio de Radiología Vascular, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Noelia
authors.initials: N
authors.lastname: Lacasa Pérez
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Cabezuelo Romero
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001783:Blood Flow Velocity; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D018615:Ultrasonography, Doppler, Color; D062666:Vascular Access Devices; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Ecografía; Failure of maturation; Fracaso de maduración; Fístula arteriovenosa radio-cefálica; Predialysis; Prediálisis; Radiocephalic arteriovenous fistula; Ultrasonography