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

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

Research output: Contribution to journalArticle

26 Scopus citations

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 1 2007

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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