Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access

Robert Mclafferty, Raymond W. Pryor, Colleen M. Johnson, Don E. Ramsey, Kim J. Hodgson

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon. Methods: Patients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperative weeks, followed by repeat examination every 6 to 8 weeks until maturation. Primary outcomes included maturation assessment and interventions required prior to maturation. Maturation was defined as 4 consecutive weeks of sustainable AVF hemodialysis access. Results: One hundred thirteen patients had 113 AVFs. Mean age was 64 years (range: 26-94) and 52% were male. AVFs included 8 (7%) radiocephalic, 90 (80%) brachiocephalic, and 15 (13%) basilic vein transposition. Overall, the maturation rate was 72% (failure rate of 28%). Excluding deaths and transplants prior to maturation, the maturation rate was 82% (failure rate 18%). Eighty-three (73%) patients had no intervention prior to maturation and 30 (27%) required intervention. There was no significant difference in failure rate between AVFs not requiring an intervention (13 of 83, 15%) and those requiring intervention (5 of 30, 16%). For AVFs requiring intervention, 23 (61%) patients had an endovascular intervention and 15 (39%) an operative intervention. One intervention was performed in 64%, two in 24%, and three in 12%. Ninety-three percent of AVFs having an endovascular intervention matured compared with 60% having operative intervention (P = .10). AVFs requiring intervention had a maturation time (mean: 35 weeks, range: 10-54) that was significantly longer (P = .003) than those without (mean 11 weeks, range: 6-35). Conclusions: With a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69%) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83%) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.

Original languageEnglish (US)
Pages (from-to)981-985
Number of pages5
JournalJournal of Vascular Surgery
Volume45
Issue number5
DOIs
StatePublished - May 2007
Externally publishedYes

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Renal Dialysis
Physical Examination
Dialysis
Veins
History
Guidelines
Transplants
Kidney
Surgeons

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. / Mclafferty, Robert; Pryor, Raymond W.; Johnson, Colleen M.; Ramsey, Don E.; Hodgson, Kim J.

In: Journal of Vascular Surgery, Vol. 45, No. 5, 05.2007, p. 981-985.

Research output: Contribution to journalArticle

Mclafferty, Robert ; Pryor, Raymond W. ; Johnson, Colleen M. ; Ramsey, Don E. ; Hodgson, Kim J. / Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. In: Journal of Vascular Surgery. 2007 ; Vol. 45, No. 5. pp. 981-985.
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abstract = "Objective: To examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon. Methods: Patients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperative weeks, followed by repeat examination every 6 to 8 weeks until maturation. Primary outcomes included maturation assessment and interventions required prior to maturation. Maturation was defined as 4 consecutive weeks of sustainable AVF hemodialysis access. Results: One hundred thirteen patients had 113 AVFs. Mean age was 64 years (range: 26-94) and 52{\%} were male. AVFs included 8 (7{\%}) radiocephalic, 90 (80{\%}) brachiocephalic, and 15 (13{\%}) basilic vein transposition. Overall, the maturation rate was 72{\%} (failure rate of 28{\%}). Excluding deaths and transplants prior to maturation, the maturation rate was 82{\%} (failure rate 18{\%}). Eighty-three (73{\%}) patients had no intervention prior to maturation and 30 (27{\%}) required intervention. There was no significant difference in failure rate between AVFs not requiring an intervention (13 of 83, 15{\%}) and those requiring intervention (5 of 30, 16{\%}). For AVFs requiring intervention, 23 (61{\%}) patients had an endovascular intervention and 15 (39{\%}) an operative intervention. One intervention was performed in 64{\%}, two in 24{\%}, and three in 12{\%}. Ninety-three percent of AVFs having an endovascular intervention matured compared with 60{\%} having operative intervention (P = .10). AVFs requiring intervention had a maturation time (mean: 35 weeks, range: 10-54) that was significantly longer (P = .003) than those without (mean 11 weeks, range: 6-35). Conclusions: With a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69{\%}) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83{\%}) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.",
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AU - Ramsey, Don E.

AU - Hodgson, Kim J.

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N2 - Objective: To examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon. Methods: Patients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperative weeks, followed by repeat examination every 6 to 8 weeks until maturation. Primary outcomes included maturation assessment and interventions required prior to maturation. Maturation was defined as 4 consecutive weeks of sustainable AVF hemodialysis access. Results: One hundred thirteen patients had 113 AVFs. Mean age was 64 years (range: 26-94) and 52% were male. AVFs included 8 (7%) radiocephalic, 90 (80%) brachiocephalic, and 15 (13%) basilic vein transposition. Overall, the maturation rate was 72% (failure rate of 28%). Excluding deaths and transplants prior to maturation, the maturation rate was 82% (failure rate 18%). Eighty-three (73%) patients had no intervention prior to maturation and 30 (27%) required intervention. There was no significant difference in failure rate between AVFs not requiring an intervention (13 of 83, 15%) and those requiring intervention (5 of 30, 16%). For AVFs requiring intervention, 23 (61%) patients had an endovascular intervention and 15 (39%) an operative intervention. One intervention was performed in 64%, two in 24%, and three in 12%. Ninety-three percent of AVFs having an endovascular intervention matured compared with 60% having operative intervention (P = .10). AVFs requiring intervention had a maturation time (mean: 35 weeks, range: 10-54) that was significantly longer (P = .003) than those without (mean 11 weeks, range: 6-35). Conclusions: With a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69%) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83%) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.

AB - Objective: To examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon. Methods: Patients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperative weeks, followed by repeat examination every 6 to 8 weeks until maturation. Primary outcomes included maturation assessment and interventions required prior to maturation. Maturation was defined as 4 consecutive weeks of sustainable AVF hemodialysis access. Results: One hundred thirteen patients had 113 AVFs. Mean age was 64 years (range: 26-94) and 52% were male. AVFs included 8 (7%) radiocephalic, 90 (80%) brachiocephalic, and 15 (13%) basilic vein transposition. Overall, the maturation rate was 72% (failure rate of 28%). Excluding deaths and transplants prior to maturation, the maturation rate was 82% (failure rate 18%). Eighty-three (73%) patients had no intervention prior to maturation and 30 (27%) required intervention. There was no significant difference in failure rate between AVFs not requiring an intervention (13 of 83, 15%) and those requiring intervention (5 of 30, 16%). For AVFs requiring intervention, 23 (61%) patients had an endovascular intervention and 15 (39%) an operative intervention. One intervention was performed in 64%, two in 24%, and three in 12%. Ninety-three percent of AVFs having an endovascular intervention matured compared with 60% having operative intervention (P = .10). AVFs requiring intervention had a maturation time (mean: 35 weeks, range: 10-54) that was significantly longer (P = .003) than those without (mean 11 weeks, range: 6-35). Conclusions: With a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69%) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83%) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.

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