Impact of a preoperative evaluation on the outcomes of an arteriovenous fistula.
10.4174/astr.2016.90.4.224
- Author:
Sung Min KIM
1
;
Youngjin HAN
;
Hyunwook KWON
;
Hee Sun HONG
;
Ji Yoon CHOI
;
Hojong PARK
;
Tae Won KWON
;
Yong Pil CHO
Author Information
1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ypcho@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Renal dialysis;
Chronic kidney failure;
Treatment outcome;
Physical examination;
Ultrasonography
- MeSH:
Arteriovenous Fistula*;
Demography;
Diabetes Mellitus;
Dialysis;
Female;
Humans;
Kidney Failure, Chronic;
Physical Examination;
Renal Dialysis;
Renal Insufficiency, Chronic;
Retrospective Studies;
Risk Factors;
Transplants;
Treatment Outcome;
Ultrasonography
- From:Annals of Surgical Treatment and Research
2016;90(4):224-230
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The aim of this study was to determine the possible predictors of primary arteriovenous fistula (AVF) failure and examine the impact of a preoperative evaluation on AVF outcomes. METHODS: A total of 539 patients who underwent assessment for a suitable site for AVF creation by physical examination alone or additional duplex ultrasound were included in this study. Demographics, patient characteristics, and AVF outcomes were analyzed retrospectively. RESULTS: AVF creation was proposed in 469 patients (87.0%) according to physical examination alone (351 patients) or additional duplex ultrasound (118 patients); a prosthetic arteriovenous graft was initially placed in the remaining 70 patients (13.0%). Although the primary failure rate was significantly higher in patients assessed by duplex ultrasound (P = 0.001), ultrasound information changed the clinical plan, increasing AVF use for dialysis, in 92 of the 188 patients (48.9%) with an insufficient physical examination. Female sex and diabetes mellitus were risk factors significantly associated with primary AVF failure. Because of different inclusion criteria and a lack of adjustment for baseline differences, Kaplan-Meier survival analysis showed better AVF outcomes in patients assessed by physical examination alone; an insufficient physical examination was the only risk factor significantly associated with AVF outcomes. CONCLUSION: Routine use of duplex ultrasound is not necessary in chronic kidney disease patients with a satisfactory physical examination. Given that female gender and diabetes mellitus are significantly associated with primary AVF failure, duplex ultrasound could be of particular benefit in these subtypes of patients without a sufficient physical examination.
