Department of Internal Medicine, Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH 45267-0585, USA.
Clin J Am Soc Nephrol. 2011 Mar;6(3):575-81. doi: 10.2215/CJN.06630810. Epub 2010 Nov 18.
New arteriovenous fistulas (AVF) are frequently unsuitable for hemodialysis because of AVF nonmaturation. Aggressive endovascular or surgical interventions are often undertaken to salvage nonmaturing AVFs. The effect of early interventions to promote AVF maturation on subsequent long-term AVF outcomes is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We evaluated 173 hemodialysis patients from two academic centers who received a new AVF. Of these, 96 (56%) required no further intervention, 54 (31%) required one intervention, and 23 (13%) required two or more interventions to achieve suitability for dialysis. We calculated AVF survival and frequency of postmaturation interventions in each group.
Cumulative AVF survival (access cannulation to permanent failure) in patients with two or more versus one versus zero interventions before maturation was 68% versus 78% versus 92% at 1 year, 57% versus 71% versus 85% at 2 years, and 42% versus 57% versus 75% at 3 years. Using Cox regression analysis with interventions before maturation, age, sex, race, diabetes, peripheral vascular disease, access site, and obesity in the model, intervention before maturation (two or more) was the only factor associated with cumulative AVF survival. The number of interventions required to maintain patency after maturation was 3.51 ± 2.20 versus 1.37 ± 0.31 versus 0.76 ± 0.10 per year in patients with two or more versus one versus zero interventions before maturation.
Compared with AVF that mature without interventions, AVF that require interventions have decreased cumulative survival and require more interventions to maintain their patency for hemodialysis.
新的动静脉瘘（AVF）常因 AVF 不成熟而不适合血液透析。为了挽救不成熟的 AVF，通常会进行积极的血管内或手术干预。早期干预促进 AVF 成熟对随后的长期 AVF 结局的影响尚不清楚。
设计、设置、参与者和测量方法：我们评估了来自两个学术中心的 173 名接受新 AVF 的血液透析患者。其中，96 名（56%）不需要进一步干预，54 名（31%）需要一次干预，23 名（13%）需要两次或更多次干预才能适合透析。我们计算了每组 AVF 的生存和成熟后干预的频率。
在成熟前接受两次或更多次、一次或零次干预的患者中，AVF 的累积生存率（从血管通路建立到永久性失功）分别为 1 年时 68%对 78%对 92%，2 年时 57%对 71%对 85%，3 年时 42%对 57%对 75%。在成熟前用 Cox 回归分析干预、年龄、性别、种族、糖尿病、外周血管疾病、血管通路部位和肥胖的模型中，成熟前的干预（两次或更多次）是与 AVF 累积生存率相关的唯一因素。在成熟后需要保持通畅所需的干预次数分别为成熟前接受两次或更多次、一次或零次干预的患者每年 3.51±2.20 次、1.37±0.31 次和 0.76±0.10 次。
与无需干预即可成熟的 AVF 相比，需要干预的 AVF 累积生存率降低，需要更多的干预来维持其用于血液透析的通畅性。
