Guideline recommendations on minimal blood vessel diameters and arteriovenous fistula outcomes

Letty V. van Vliet, Niek Zonnebeld, Jan H. Tordoir, Wouter Huberts, Lee H. Bouwman, Philippe W. Cuypers, Stefan G. Heinen, Laurens C. Huisman, Susan Lemson, Barend M. E. Mees, Felix J. Schlosser, Andre A. de Smet, Raechel J. Toorop, Tammo Delhaas, Maarten G. Snoeijs*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Clinical guidelines provide recommendations on the minimal blood vessel diameters required for arteriovenous fistula creation but the evidence for these recommendations is limited. We compared vascular access outcomes of fistulas created in agreement with the ESVS Clinical Practice Guidelines (i.e. arteries and veins >2 mm for forearm fistulas and >3 mm for upper arm fistulas) with fistulas created outside these recommendations. Methods: The multicenter Shunt Simulation Study cohort contains 211 hemodialysis patients who received a first radiocephalic, brachiocephalic, or brachiobasilic fistula before publication of the ESVS Clinical Practice Guidelines. All patients had preoperative duplex ultrasound measurements according to a standardized protocol. Outcomes included duplex ultrasound findings at 6 weeks after surgery, vascular access function, and intervention rates until 1 year after surgery. Results: In 55% of patients, fistulas were created in agreement with the ESVS Clinical Practice Guidelines recommendations on minimal blood vessel diameters. Concordance with the guideline recommendations was more frequent for forearm fistulas than for upper arm fistulas (65% vs 46%, p = 0.01). In the entire cohort, agreement with the guideline recommendations was not associated with an increased proportion of functional vascular accesses (70% vs 66% for fistulas created within and outside guideline recommendations, respectively; p = 0.61) or with decreased access-related intervention rates (1.45 vs 1.68 per patient-year, p = 0.20). In forearm fistulas, however, only 52% of arteriovenous fistulas created outside these recommendations developed into a timely functional vascular access. Conclusions: Whereas upper arm arteriovenous fistulas with preoperative blood vessel diameters <3 mm had similar vascular access function as fistulas created with larger blood vessels, forearm arteriovenous fistulas with preoperative blood vessel diameters <2 mm had poor clinical outcomes. These results support that clinical decision-making should be guided by an individual approach.
Original languageEnglish
Pages (from-to)1584-1592
Number of pages9
JournalJournal of vascular access
Volume25
Issue number5
Early online date1 Jun 2023
DOIs
Publication statusPublished - Sept 2024

Keywords

  • Arteriovenous fistula
  • hemodialysis
  • preoperative diameter
  • vascular access function
  • cohort study
  • HEMODIALYSIS
  • MATURATION
  • CREATION
  • ACCESS

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