title: Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.
abstract: BACKGROUND
  Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM.
  
  
  METHODS
  This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated.
  
  
  RESULTS
  Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P< 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively).
  
  
  CONCLUSIONS
  Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Salimi
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Shahab
authors.initials: S
authors.lastname: Shahabi
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Talebzadeh
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Keshavarzian
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Pourfakharan
authors.affiliation: Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Safaei
keywords: Arteriovenous fistulas; clinical examination; hemodialysis; maturation