Risk Factors of Non-matured Arteriovenous Fistula Despite Routine Use of Preoperative Duplex Ultrasound

Abstract

Background: Preoperative duplex ultrasonography for planning the AVF may improve the success rate of AVF creation. Despite routine use of preoperative duplex ultrasonography, there are some of the patients still have non-maturation problem.

Objective: To evaluate incidence and risk factors of non-matured arteriovenous fistula even though routine use of preoperative duplex ultrasound at Nakhonpathom Hospital.

Methods: The data were retrospectively reviewed from a prospectively collected database. Between August 2013 to March 2015, there were 365 new AVF and AVG procedures performed by the author at Nakhonpathom Hospital. Demographic data, maturation rate and risk factors for nonmaturation were analyzed.

Results: There were 301 patients (82.47%) underwent AVF and 64 patients (17.53%) underwent AVG in that period. In 301 patients who underwent AVF, 19 patients were lost to follow up and 9 patients died before maturation evaluation. In 273 patients who complete follow-up, non-maturation rate was 6.22% (17/273). The significant risk factors for non-matured AVF were vein diameter (p=0.020) and history of previous central venous catheter on the AVF side (p=0.019). Underlying disease, demographic data of the patients (DM, HT, DLP, gout, IHD, smoking, BMI, age) and artery diameter were not influenced the maturation rate of the AVF

Conclusions: The routine use of preoperative duplex ultrasound may increase the maturation rate of the AVF up to 90%. The risk factors for non-matured AVF were vein diameter and history of previous central venous catheter on the AVF side.