Publicação
Predictive factors for brachiocephalic and brachiobasilic arteriovenous fistula success : role of colour doppler ultrasound
| Resumo: | INTRODUCTION: End stage renal disease (ESRD) is increasing worldwide. Hemodialysis is the most frequent renal replacement therapy. Dysfunction and vascular access complications account for 20-30% of hospital admissions with high morbidity, high mortality and high economic burden. International societies recommend pre-operative colour Doppler ultrasound (CDUS) vascular mapping in addition to physical examination. It is not consensual whether pre-operative vascular mapping is associated with higher success in vascular access surgery. Current scientific evidence, based on clinical, anatomical and hemodynamic criteria, is insufficient to determine the best vascular access for each patient. AIM: To evaluate pre-operative anatomical and hemodynamic parameters measured by Doppler ultrasound as predictors of brachiocephalic an brachiobasilic arteriovenous fistula early success. METHODS: Observational, analytical, prospective analysis of patients (n=132) who underwent brachiocephalic or brachiobasilic AVF surgery between January 2016 and May 2017. Outcomes: primary patency at 48 hours, fistula success at six weeks and twelve weeks measured clinically and by CDUS. Variables: patient’s demographics, comorbidities, medication, CDUS derived pre-operative parameters and immediate pre-operative hemodynamic parameters. Non-parametric statistic was used. Univariate analysis and multivariate analysis with logistic regression models were performed. ROC curve analyses were performed for independent predictive factors. RESULTS: Primary patency at 48h was 91.7%, AVF success at 6 weeks was 71.3% and AVF success at 12 weeks was66.3%. There were no associations inunivariate and multivariate logistic regression analysis between AVF patency and AVF success and demographics, CKD factors and comorbidities. Immediate pre-operative systolic blood pressure was an independent predictor of 48h patency with an optimized cut-off of 154mmHg (AUC=0.73; p=0.013; Youden index=0.40). Vein diameter with tourniquet was an independent predictor of AVF success at 6 weeks and 12 weeks with an optimized cut-off of 3.9mm (AUC=0.69; p=0.004; Youden index=0.29 and AUC=0.74; p<0.001; Youden index=0.38, respectively). Paired analysis comparing 6 weeks and 12 weeks CDUS-derived parameters showed no statistical differences between AVF blood flow, peak systolic velocity and resistance index. Vein diameter was higher at 12 weeks’ follow-up compared to 6 weeks (median=8.40mm (IQR=3.00) vs 7.40 (IQR=2.70), respectively; p<0.001). CONCLUSIONS: AVF success was independent of demographics, CKD stage and comorbidities. Immediate pre-operative systolic blood pressure was an independent predictive factor for primary patency at 48h with an optimized cut-off of 154mmHg. Vein diameter with tourniquet was an independent predictive factor for fistula success at 6 and 12 weeks with an optimized cut-off of 3.9mm. |
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| Autores principais: | Gomes, António Pedro da Silva Pinto, 1981- |
| Assunto: | Arterivenous fistula Colour Doppler Ultrasound Hemodialysis Predictive factors Primary patency Teses de mestrado - 2018 |
| Ano: | 2018 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | INTRODUCTION: End stage renal disease (ESRD) is increasing worldwide. Hemodialysis is the most frequent renal replacement therapy. Dysfunction and vascular access complications account for 20-30% of hospital admissions with high morbidity, high mortality and high economic burden. International societies recommend pre-operative colour Doppler ultrasound (CDUS) vascular mapping in addition to physical examination. It is not consensual whether pre-operative vascular mapping is associated with higher success in vascular access surgery. Current scientific evidence, based on clinical, anatomical and hemodynamic criteria, is insufficient to determine the best vascular access for each patient. AIM: To evaluate pre-operative anatomical and hemodynamic parameters measured by Doppler ultrasound as predictors of brachiocephalic an brachiobasilic arteriovenous fistula early success. METHODS: Observational, analytical, prospective analysis of patients (n=132) who underwent brachiocephalic or brachiobasilic AVF surgery between January 2016 and May 2017. Outcomes: primary patency at 48 hours, fistula success at six weeks and twelve weeks measured clinically and by CDUS. Variables: patient’s demographics, comorbidities, medication, CDUS derived pre-operative parameters and immediate pre-operative hemodynamic parameters. Non-parametric statistic was used. Univariate analysis and multivariate analysis with logistic regression models were performed. ROC curve analyses were performed for independent predictive factors. RESULTS: Primary patency at 48h was 91.7%, AVF success at 6 weeks was 71.3% and AVF success at 12 weeks was66.3%. There were no associations inunivariate and multivariate logistic regression analysis between AVF patency and AVF success and demographics, CKD factors and comorbidities. Immediate pre-operative systolic blood pressure was an independent predictor of 48h patency with an optimized cut-off of 154mmHg (AUC=0.73; p=0.013; Youden index=0.40). Vein diameter with tourniquet was an independent predictor of AVF success at 6 weeks and 12 weeks with an optimized cut-off of 3.9mm (AUC=0.69; p=0.004; Youden index=0.29 and AUC=0.74; p<0.001; Youden index=0.38, respectively). Paired analysis comparing 6 weeks and 12 weeks CDUS-derived parameters showed no statistical differences between AVF blood flow, peak systolic velocity and resistance index. Vein diameter was higher at 12 weeks’ follow-up compared to 6 weeks (median=8.40mm (IQR=3.00) vs 7.40 (IQR=2.70), respectively; p<0.001). CONCLUSIONS: AVF success was independent of demographics, CKD stage and comorbidities. Immediate pre-operative systolic blood pressure was an independent predictive factor for primary patency at 48h with an optimized cut-off of 154mmHg. Vein diameter with tourniquet was an independent predictive factor for fistula success at 6 and 12 weeks with an optimized cut-off of 3.9mm. |
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