title: Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single-centre experience.
abstract: OBJECTIVE
  Vascular access in haemodialysis is critical for effective therapy. We aim to evaluate the outcomes of arteriovenous fistula (AVF) creation in incident haemodialysis patients, impact of preoperative vein mapping and predictors of successful AVF maturation in our centre.
  
  
  METHODS
  Data of End-stage Renal Disease (ESRD) patients initiated on haemodialysis from January 2010 to December 2012 in our centre were retrospectively obtained from electronic medical records and clinical notes. Demographic characteristics, medical comorbidities, perioperative details were collected, and patients were followed up until 1 January 2014.
  
  
  RESULTS
  A total of 708 patients (median age 64, IQR 55-72) were included with mean duration of follow up of 2.3 ± 1.2 years, with access of AVF and arteriovenous graft (AVG) in 694 (98%) and 14 (2%) patients respectively. Eight patients were lost to follow-up. Successful AVF maturation was achieved in 542 patients (78%), with 1-year cumulative patency rate of 74%. Multivariate analysis revealed male gender, upper arm AVF and good postoperative thrill and pulse as predictors of successful AVF maturation. Preoperative vein mapping was performed in 42.5% (295/694) of patients, with mean vein diameter of 2.44 ± 0.82 mm. Maturation rates with and without vein mapping were 72.2% and 82.4%, respectively, (P = 0.001). In patients with vein diameters of <2 mm and ≥2 mm, there was no statistically significant difference in maturation rates (71.3% vs. 72.6%; P = 0.887) and median maturation time (66 vs. 78 days; P = 0.73).
  
  
  CONCLUSIONS
  Arteriovenous fistula can be successfully created in most incident haemodialysis patients. Routine vein mapping is not necessary if veins are suitable on physical examination alone, and vein sizes of <2 mm on ultrasound is not associated with lower AVF maturation rate.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Kian-Guan
authors.initials: KG
authors.lastname: Lee
authors.affiliation: Department of Vascular Surgery, Singapore General Hospital, Singapore.
authors.forename: Tze-Tec
authors.initials: TT
authors.lastname: Chong
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Nicholette
authors.initials: N
authors.lastname: Goh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Shaam
authors.initials: S
authors.lastname: Achudan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Yi-Liang
authors.initials: YL
authors.lastname: Tan
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Ru-Yu
authors.initials: RY
authors.lastname: Tan
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Choong
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Chieh-Suai
authors.initials: CS
authors.lastname: Tan
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D011237:Predictive Value of Tests; D011300:Preoperative Care; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D019564:Unnecessary Procedures; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: arteriovenous fistula; haemodialysis; primary patency; vein mapping