Department of Nephrology-Hemodialysis and Therapeutic Apheresis, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France.
Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France.
Ren Fail. 2024 Dec;46(2):2420829. doi: 10.1080/0886022X.2024.2420829. Epub 2024 Oct 30.
Arteriovenous-fistula (AVF) are crucial for hemodialysis access, yet they frequently experience early failure. While studies have identified potential patient and clinical risk factors, these findings remain inconsistent. This inconsistency might be attributed to the varying definitions of "early failure". Our retrospective cohort study aimed to evaluate how common risk factors predict four frequently early-failure criteria: thrombosis/stenosis, <500 ml/min blood flow, <5 mm vein diameter, and ≥6 mm deep vein. We also assessed how well these risk factors predict early failure defined as meeting at least one of these criteria. Additionally, we examined the predictive ability of vein-distensibility, a previously overlooked factor in AVF failure.
Consecutive patients with first-time AVF employing standard minimum preoperative artery- and vein-diameters (1.8-2.0 mm) who underwent first Doppler-ultrasound (DUS) at ≤4 months in 2016-2022 were identified. Early AVF failure was defined as the presence of at least one of the following conditions on the first DUS: poor blood flow (Qa), poor vein diameter, poor vein depth, and thrombosis/stenosis. Factors associated with early AVF failure were explored with multivariate analyses.
105 patients were eligible and 63 (60%) had an early AVF failure. The only strong predictor of early failure was low vein-distensibility (Odds ratio = 0.57, 95% confidence intervals [CIs] = 0.38-0.83, = 0.005). Female sex only predicted too-deep veins (Odds ratio = 14.29, 95% CIs = 2.00-100, = 0.024).
venous distensibility may be a useful early-failure determinant when minimum preoperative vessel-diameter limits are met. Moreover, the female sex is associated with too-deep AVF veins.
动静脉瘘（AVF）是血液透析通路的关键，但它们经常早期失败。虽然研究已经确定了潜在的患者和临床风险因素，但这些发现仍然不一致。这种不一致可能归因于“早期失败”的不同定义。我们的回顾性队列研究旨在评估常见的风险因素如何预测四种常见的早期失败标准：血栓形成/狭窄、<500ml/min 血流量、<5mm 静脉直径和≥6mm 深静脉。我们还评估了这些风险因素预测至少符合这些标准之一的早期失败的能力。此外，我们还研究了静脉可扩张性，这是 AVF 失败中一个以前被忽视的因素。
连续入选 2016 年至 2022 年期间首次接受动静脉瘘术、术前动脉和静脉直径均为 1.8-2.0mm、≤4 个月内行首次多普勒超声（DUS）检查的患者。早期动静脉瘘失败定义为首次 DUS 上存在以下至少一种情况：血流不良（Qa）、静脉直径不良、静脉深度不良和血栓形成/狭窄。采用多变量分析探讨与早期动静脉瘘失败相关的因素。
105 名患者符合条件，其中 63 名（60%）发生早期动静脉瘘失败。早期动静脉瘘失败的唯一强预测因素是静脉可扩张性低（优势比=0.57，95%置信区间[CI]为 0.38-0.83， = 0.005）。女性仅预测静脉过深（优势比=14.29，95%CI 为 2.00-100， = 0.024）。
当满足术前最小血管直径限制时，静脉可扩张性可能是早期失败的一个有用的决定因素。此外，女性与动静脉瘘过深有关。
