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Patients referred for arteriovenous fistula construction: a retrospective outcome analysis.

Abstract

OBJECTIVES

With lower rates of sepsis and re-interventions, arteriovenous fistula (AVF) is the preferred vascular access modality. The aim of this study is to evaluate the outcomes of patients referred for AVF construction at a single center in Cork, Ireland.

METHODS

The current study is a single-center retrospective review of all patients who underwent AVF creation between 2015 and 2017. Additionally, the kidney disease clinical patient management system was used to provide statistics on AVF use in Ireland.

RESULTS

39.3% of hemodialysis patients in Ireland use an AVF for vascular access. Regional use ranged from 50 to 20% across Irish hemodialysis centers. At Cork University Hospital, 192 AVFs were created. The population was 69.3% male (n = 133), 30.7% female (n = 59) with a mean (±SEM) age of 58.8 ± 1.03 years. 69.5% of females received a brachiocephalic AVF (BCAVF) while 13.6% had a radiocephalic AVF (RCAVF) constructed. Significance was seen when comparing gender and AVF type (p < 0.001). Fifty-four percent of the fistulae were brachiocephalic (n = 103), 33% were radiocephalic (n = 63), and 4% were brachiobasilic (n = 8). BCAVF patients (62.7 ± 1.2 years) were significantly older than patients receiving a RCAVF (54.5 ± 1.9 years, p < 0.001). A post-operative thrill or continuous flow on Doppler was present in 99% of patients (n = 190) with maturation and complication rates of 82.7% (n = 153) and 5.7% (n = 11) respectively. 69.9% of AVFs were needled for hemodialysis (n = 114).

CONCLUSIONS

AVF outcomes at this center are consistent with reported statistics in the literature. Patient age, sex, and diabetic status may influence the use of proximal AVF. AVF creation rates in Ireland are below international reported recommendations.

Authors+Show Affiliations

School of Medicine, University College Cork, Cork, Republic of Ireland. 116100312@umail.ucc.ie.Department of Vascular Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland.Department of Renal Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland.School of Medicine, University College Cork, Cork, Republic of Ireland. Department of Vascular Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland.School of Medicine, University College Cork, Cork, Republic of Ireland. Department of Renal Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland.School of Medicine, University College Cork, Cork, Republic of Ireland. Department of Vascular Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31473915

Citation

Kucey, Andrew S., et al. "Patients Referred for Arteriovenous Fistula Construction: a Retrospective Outcome Analysis." Irish Journal of Medical Science, 2019.
Kucey AS, Joyce DP, O'Neill T, et al. Patients referred for arteriovenous fistula construction: a retrospective outcome analysis. Ir J Med Sci. 2019.
Kucey, A. S., Joyce, D. P., O'Neill, T., Fulton, G. J., Plant, W. D., & Manning, B. J. (2019). Patients referred for arteriovenous fistula construction: a retrospective outcome analysis. Irish Journal of Medical Science, doi:10.1007/s11845-019-02090-9.
Kucey AS, et al. Patients Referred for Arteriovenous Fistula Construction: a Retrospective Outcome Analysis. Ir J Med Sci. 2019 Aug 31; PubMed PMID: 31473915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients referred for arteriovenous fistula construction: a retrospective outcome analysis. AU - Kucey,Andrew S, AU - Joyce,Doireann P, AU - O'Neill,Teresa, AU - Fulton,Gregory J, AU - Plant,William D, AU - Manning,Brian J, Y1 - 2019/08/31/ PY - 2019/04/06/received PY - 2019/08/26/accepted PY - 2019/9/2/entrez PY - 2019/9/2/pubmed PY - 2019/9/2/medline KW - AVF KW - Brachiocephalic fistula KW - Chronic kidney disease KW - End-stage kidney disease KW - Fistula maturation KW - Hemodialysis KW - Radiocephalic fistula KW - Vascular access JF - Irish journal of medical science JO - Ir J Med Sci N2 - OBJECTIVES: With lower rates of sepsis and re-interventions, arteriovenous fistula (AVF) is the preferred vascular access modality. The aim of this study is to evaluate the outcomes of patients referred for AVF construction at a single center in Cork, Ireland. METHODS: The current study is a single-center retrospective review of all patients who underwent AVF creation between 2015 and 2017. Additionally, the kidney disease clinical patient management system was used to provide statistics on AVF use in Ireland. RESULTS: 39.3% of hemodialysis patients in Ireland use an AVF for vascular access. Regional use ranged from 50 to 20% across Irish hemodialysis centers. At Cork University Hospital, 192 AVFs were created. The population was 69.3% male (n = 133), 30.7% female (n = 59) with a mean (±SEM) age of 58.8 ± 1.03 years. 69.5% of females received a brachiocephalic AVF (BCAVF) while 13.6% had a radiocephalic AVF (RCAVF) constructed. Significance was seen when comparing gender and AVF type (p < 0.001). Fifty-four percent of the fistulae were brachiocephalic (n = 103), 33% were radiocephalic (n = 63), and 4% were brachiobasilic (n = 8). BCAVF patients (62.7 ± 1.2 years) were significantly older than patients receiving a RCAVF (54.5 ± 1.9 years, p < 0.001). A post-operative thrill or continuous flow on Doppler was present in 99% of patients (n = 190) with maturation and complication rates of 82.7% (n = 153) and 5.7% (n = 11) respectively. 69.9% of AVFs were needled for hemodialysis (n = 114). CONCLUSIONS: AVF outcomes at this center are consistent with reported statistics in the literature. Patient age, sex, and diabetic status may influence the use of proximal AVF. AVF creation rates in Ireland are below international reported recommendations. SN - 1863-4362 UR - https://www.unboundmedicine.com/medline/citation/31473915/Patients_referred_for_arteriovenous_fistula_construction:_a_retrospective_outcome_analysis L2 - https://dx.doi.org/10.1007/s11845-019-02090-9 DB - PRIME DP - Unbound Medicine ER -