title: Clinical Utility of a New Predicting Score for Radiocephalic Arteriovenous Fistula Survival.
abstract: BACKGROUND
  Radiocephalic arteriovenous fistula (RC-AVF) is the recommended first choice for vascular access (VA). The CAVeA2T2scoring system was recently published (ipsilateral central venous catheter access, age >73 years, vein <2.2 mm, lower limb angioplasty, and absent intraoperative thrill). The aim of the present study was to assess the clinical utility of the CAVeA2T2scoring system for predicting RC-AVFs survival in our center and its subsequent application in VA management.
  
  
  METHODS
  In this single-center retrospective study, all RC-AVFs performed from January 2010 to July 2014 were included. The CAVeA2T2was applied. Primary, assisted primary, and secondary patency rates were measured.
  
  
  RESULTS
  Sixty RC-AVFs were analyzed. Mean age was 64.3 ± 14.7 years. Mean CAVeA2T2score was 1.23 ± 1.2. The median fistula secondary patency was 13.7 ± 1.6 months. Secondary patency was at 6 weeks and at 6, 12, and 24 months: 88.3%, 66.7%, 55%, and 31.7%, respectively. Increasing score (≥2) was associated with a decrease in primary (log-rank, χ2= 16.7, dif = 1, P = 0.0001) and secondary patency rate survival (log-rank, χ2= 5.4, dif = 1, P = 0.0001). In addition, stratification of the CAVeA2T2score into 3 groups (scores 0-1, 2, and 3+) retained its significance for primary (log-rank, χ2= 19.4, dif = 2, P = 0.0001) and secondary patency rate survival (log-rank, χ2= 5.5, dif = 2, P = 0.046) at the end of the study.
  
  
  CONCLUSIONS
  In the present study, the CAVeA2T2scoring system has proved to be a useful, easy to apply tool that is highly predictive of RC-AVF survival. Based on our results, we should avoid perform RC-AVFs, in those patients with CAVeA2T2score ≥2 and late nephrology referral. Prospective studies should be designed to establish the management of patients with a higher CAVeA2T2score.
authors.affiliation: Vascular Surgery Department, Hospital of Terrassa, Consorci Sanitari de Terrassa (CST), Barcelona, Spain; Surgery Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Electronic address: LIMartinez@CST.CAT.
authors.forename: Lucia I
authors.initials: LI
authors.lastname: Martinez
authors.affiliation: Nephrology Department, Hospital of Terrassa, Consorci Sanitari de Terrassa (CST), Barcelona, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Esteve
authors.affiliation: Vascular Surgery Department, Hospital of Terrassa, Consorci Sanitari de Terrassa (CST), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Yeste
authors.affiliation: General Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Artigas
authors.affiliation: Vascular Surgery Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
authors.forename: Secundino
authors.initials: S
authors.lastname: Llagostera
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*