Abstract
Distal radio-cephalic arteriovenous fistula is the ‘gold standard’ vascular access for chronic hemodialysis. Its main drawback is early failure, which can complicate up to 50 % of this surgical procedure. Two scenarios of failure are possible: early post-operative thrombosis or impaired maturation. The first is mainly due to a defective preoperative evaluation or poor surgical procedure. The latter is a patent angioaccess unable to deliver adequately hemodialysis due to a persistently low blood flow or difficult cannulation. In this article, the causes of impaired maturation will be reviewed, ranging from the stenosis causing low flow to the deep location of the vein in the obese. Treatment options will be described in thorough technical detail, in order to allow the angioaccess team to master them in daily practice.
Similar content being viewed by others
References
Brescia MJ, Cimino JE, Appel K et al (1966) Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092
Vascular Access Work Group (2006) Clinical practice guidelines for vascular access. Am J Kidney Dis 48(Suppl 1):S176–S247
Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor M, Wanner C, TerWee P, Vanholder R (2007) EBPG on vascular access. Nephrol Dial Transplant 22(Suppl 2):ii88–ii117
Allon M, Robbin ML et al (2002) Increasing arteriovenous fistula in hemodialysis patients: problems and solutions. Kidney Int 62:1109–1124
Rooijens PP, Tordoir JH, Stjnen T et al (2004) Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 20:583–589
Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN (2007) A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 45(2):420–426
Tordoir JHM, Bode AS, van Loon MM (2015) Preferred strategy for hemodialysis access creation in elderly patients. Eur J Vasc Endovasc Surg 49(6):738–743
Lomonte C, Forneris G, Gallieni M, Tazza L, Meola M, Lodi M, Senatore M, Morale W, Spina M, Napoli M, Bonucchi D, Galli F (2016) The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology. J Nephrol [Epub ahead of print]
Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A (1996) Factors associated with early failure of arteriovenous fistulae for hemodialysis access. Eur J Endovasc Surg 12:207–213
Chiang WC, Lin SL, Tsai TJ, Hsieh BS (2001) High resistive index of the radial artery is related to early primary radiocephalic hemodialysis fistula failure. Clin Nephrol 56(3):236–240
Voormolen EH, Jahrome AK, Bartels LW, Moll FL, Mali WP, Blankestijn PJ (2009) Nonmaturation of arm arteriovenous fistulas for hemodialysis access: a systematic review of risk factors and results of early treatment. J Vasc Surg 49 (5):1325–1336
Beathard GA, Settle SM, Shieelds MW (1999) Salvage of the non functioning arteriovenous fistula. Am J Kidney Dis 33(5):910–916
Turmel-Rodrigues L, Mouton A, Birmelé B, Billaux L, Ammar N, Grézard O, Hauss S, Pengloan J (2001) Salvage of immature forearm fistulas for hemodialysis by interventional radiology. Nephrol Dial Transplant 16:2365–2371
Beathard GA, Arnold P, Jackson J, Litchfield T (2003) Aggressive treatment of early fistula failure Kidney Int 64(4):1487–1494
Corpataux JM, Haesler E, Silacci P et al (2002) Low-pressure environment and remodeling of the forearm vein in Brescia-Cimino hemodialysis access. Nephrol Dial Transplant 17:1057–1062
Lehoux ST, Tronc F, Tedgui A et al (2002) Mechanisms of blood flow-induced vascular enlargement. Biorheology 39:319–324
Barbara BJ, Dardik A, Eng E et al (1998) Shear stress and the endothelium. Kidney Int Suppl 67:S100–S108
Tordoir JHM, Rooyens P, Dammers R, van der Sande FM, de Haan M, Yo TI (2003) Prospective evaluation of failure modes in autogenous radiocephalic wrist access for hemodialysis. Nephrol Dial Transplant 18:378–383
Lomonte C casucci F Antonelli M Giammaria B Losurdo N Marchio G Basile C (2005) Is there place for duplex screening of the brechial artery in the maturation of arteriovenous fistola? Sem Dial 18(3):243–246
Coentrao L (2013) Turmel Rodrigues L Monitoring dialysis arteriovenous fistulae:it’s in our hands. J Vasc Access 14(3):209–2015
Wiese P, Nonnast-Daniel B (2004) Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant 19:1956–1963
Franco G (2003) Contribution of ultrasonogrphy in late maturation of native fistulae for chronic hemodialysis. J Mal Vasc 28(4):194–199
Ponsin JC, Levy B, Martineaud JP (1983) Retentissement cardiaque du débit de la fistule artério-veineuse: étude chez 66 hémodialysés chroniques. Presse Med 12:4
Shin S, Do Y, Choo S, Lieu W, Choo I (2005) Salvage of immature arteriovenous fistulas with Percutaneous transluminal angioplasty Cardiovasc Intervent Radiol (28):434–438
Tessitore N, Mansueto C, Lipari C (2006) Endovascular versus surgicaal preemptive repair of forearm arteriovenosu fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004. Clin J Am Soc Nephrol 1:448–454
Pirozzi N, Garcia-Medina J, Hanoy M (2014) Stenosis complicating vascular access for hemodialysis: indication for treatment. J Vasc Access 15(supp l7):45–49
Guerra A, Raynaud A, Beyssen B, Pagny JY, Sapoval M, Angel C (2002) Arterial percutaneous angioplasty in upper limbs with vascular access devices for hemodialysis. Nephrol Dial Transplant 17:843–851
Raynaud A, Novelli L, Bourquelot P, Stolba J, Beyssen B, Franco G (2009) Low-flow maturation failure of distal accesses: treatment by angioplasty of forearm arteries. J Vasc Surg 49(4):995–999
Turmel-Rodrigues L, Boutin JM, Camiade C, Brillet G, Fodil-Chérif M, Mouton A (2009) Percutaneous dilation of the radial artery in nonmaturing autogenous radial-cephalic fistulas for hemodialysis. Nephrol Dial Transplant 24(12):3782–3788
Turmel Rodrigues L (2014) Mechanical enhancement of AVF maturation. J Vasc Access 15(suppl 7):s55–s59
Georgiadis GS, Georgakarakos EI, Antoniou GA, Panagoutsos S, Argyriou C, Mourvati E, Passadakis P, Lazarides MK (2014) Correlation of pre-existing radial artery macrocalcification with late patency of primary radio-cephalic fistulas in diabetic hemodialisis patients J Vasc Surg 60(2):462–470
Pirozzi N, Apponi F, Napoletano AM, Luciani R, Pirozzi V, Pugliese F (2010) Microsurgery and preventive hemostasis for autogenous radial-cephalic direct wrist access in adult patients with radial artery internal diameter below 1.6 mm. Nephrol Dial Transplant 25(2):520–525
Bharat A, Jaenicke M, Shenoy S (2012) A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation. J Vasc Surg 55(1):274–280
Badero OJ, Salifu MO, Wasse H, Work J (2007) Frequency of swing segment stenosis in referred dialysis patients with angiographically documented lesion. Am J Kidney Dis 51:93–98
Remuzzi A, Ene Lordache B (2013) Novel paradigm for dialysis vascular access:upstream hemodinamics and vascular remodeling in dialysis access stenosis. Clin J Am Soc Nephrol 8(12):2186–2193
Mihmanl I, Besirli K, Kurugoglu S, Atakir K, Haider S, Ogut G, Numan F, Canturk E, Sayin AG (2001) Cephalic vein and hemodialysis fistula: surgeon’s observation versus color Doppler ultrasonographic findings. J Ultrasound Med 20:217–222
Lemson MS, Leunissen KLL, Tordoir JHM (1998) Does preoperative duplex examination improve patencyrates of Brescia-Cimino fistulas? Nephrol Dial Transplant 13:1360–1361
Georgiadis GS, Charalampidis DG, Argyriou C, Georgakaracos EI, Lazarides MK (2015) The necessity for routine pre-operative ultrasound mapping before arteriovenous fistula creation: a meta-analysis. Eur J Vasc Endovasc Surg 49(5):600–605
Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, Allon M (2002) Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 225:59–64
Pirozzi N, Giuliani A, Scrivano J, Pettorini L, Fazzari L, Punzo G, Menè P (2015) Echographic Landmark of cephalic and collateeral acccessory vein at forearm in preoperative evaluation for hemodialysis angioaccess J Vasc Access 16(5):364–366
Tordoir JH, van loon MM, Peppelenbosch N, Bode AS, Poeze M, van der Sande FM (2010) Surgical technique to improve cannulation of hemodialysis vascular access Eur J Vasc Endovasc Surg 39(3):333–339
Bourquelot P, Tawakol JB, Gaudric J, Natario A, Franco G, Turmel-Rodrigues L, Van Laere O, Raynaud A (2009) Lipectomy as a new approach to secondary procedure superficialisation of diret autogenous forearm radial cephalic arteriovenouus accesses for hemodialysis. J Vasc Surg 50(2):369–374
Bourquelot P, Karam L Robert-Ebadi H, Pirozzi N (2015) Trasposition, elevation, lipectomy and V-Wing for easy needling. J Vasc Access 16(suppl 9):s108–s113]
Weyde W, Krajewska M, Letachowicz W, Porazko T, Watorek E, Kusztal M, Banasik M, Golebiowski T, Bartosik H, Madziarska K, Janczak D, Klinger M (2008) Obesity is not an obstacle for successful autogenous arteriovenous fistula creation in hemodialysis. Nephrol Dial Transplant 23:1318–1322
Turmel Rodrigues L Bourquelot P, Pengloan J (2003) Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 227 (3): 906–907 (author reply 907)
Turmel Rodigues L (2004) The search for maturity. Kidney Int 66(3):128–129
Pirozzi N, Garcia-Medina J, Hanoy M (2014) Stenosis complicating vascular access for hemodialysis: indication for treatment. J Vasc Access 15(suppl7):45–49
Coentrao L Turmel Rodrigues L (2013) Monitoring dialysis arteriovenous fistulae:it’s in our hands J Vasc Access 14(3):209–2015
Leon C, Asif A (2008) Physical examination of arteriovenous fistulae by a renal fellow: does it compares favorably to an experienced interventionalist? Sem Dial 21:557
Back MR, Maynard M, Winkler A, Bandyk DF (2008) Expected flow parameters within hemodialysis access and selection for remedial intervention of nonmaturing conduits. Vasc Endovascular Surg 42(2):150–158
Malovrh M (2014) Postopperative assessment of vascular access. J Vasc Access 15(Supp l7):s10–s14
Lazarides MK, Staramos DN, Kopadis G, Maltezos C, Tzilalis VD, Georgiadis GS (2003) Onset of arterial ‘steal’ following proximal angioaccess: immediate and delayed types. Nephrol Dial Transplant 18:2387–2390
Keuter XH, Kessels AG, de Haan MH, van der Sande FM, Tordoir JH (2008) Prospective evaluation of ischemia in brachial basilica and forearm prosthetic arteriovenous fistulas for hemodialysis. Eur J Vasc Endovasc Surg 35(5):619–624
Konner K, Hulbert-Shearon TE, Roys EC, Port FK (2002) Tailoring the initial vascular access for dialysis patients. Kidney Int 62(1):329–38
Mickley V1, Cazzonelli M, Bossinger A (2003) The stenosed Brescia-Cimino fistula: operation or intervention? Zentralbl Chir 128(9):757–761
Long B, Brichart N, Lermusiaux P et al (2011) Perianstomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous access for dialysis: transluminal angioplasty or surgery? J Vasc Surg 53:108–114
Lee T, Tindni A, Roy-Chaudhury P (2013) Improved cumulative survival in fistulas requiring surgical interventions to promote fistula maturation compared with endovascular interventions. Sem Dial 26(1):85–89
Bourquelot P Pirozzi N (2014) Tips and tricks in creation of forearm arteriovenous fistulae. J Vasc Access 15(suppl 7):s45–s49
Pirozzi N, Scrivano J, Pettorini L, Baldinelli M, Punzo G, Menè P (2013) Preventive hemostasis for hemodialysis vascular access surgical reinterventions. J Vasc Access 14(2):193–195
Eidelman M1, Katzman A, Bialik V (2006) A novel elastic exsanguination tourniquet as an alternative to the pneumatic cuff in pediatric orthopedic limb surgery. J Pediatr Orthop B 15(5):379–384
Ladenheim E, Krauthammer J, Agrawal S, Lum C, Chadwick N (2013) A sterile elastic exsanguination tourniquet is effective in preventing blood loss during hemodialysis access surgery. J Vasc Access 14(2):116–119
Turmell Rodrigues L, Beyssen B, Renaud CJ (2013) Dilatation and Stent placement. In: Turmell Rodrigues L, Renaud CJ (eds) Diagnostic and interventional radiology of arteriovenous accesses for hemodialysis, pp 65–130, Springer
Argyriou C, Schoretsanitis N, Georgakarakos EI, Georgiadis GS, Lazarides MK (2015) Preemptive open surgical vs. endovascular repair for juxta-anastomotic stenoses of autogenous AV fistulae: a meta-analysis. J Vasc Access 16(6):454–458
Chawla A, DiRaimo R, Panetta TF (2011) Balloon angioplasty to facilitate autogenous arteriovenous access maturation: a new paradigm for upgrading small-caliber veins, improved function, and surveillance. Semin Vasc Surg 24(2):82–88
Lee T, Ullah A, Allon M, Succop P, El Khatib M, Munda R, Roy-Chaudhury P (2011) Decreased cumulative access survival in arteriovenous fistulas requiring interventions to promote maturation. Clin J Am Soc Nephrol 6:575–581
Bourquelot P (2012) Access Induced Distal Ischemia. In: Asif A, Agarwal AK, Yevzlin AS, Wu S, Bethard G (eds) Interventional nephrology. McGraw-Hill Co
Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N (2008) The relationship between flow of arteriovenous fistula and cardiac output in hemodialysis patients. Nephrol Dial Transplant 23:282–287
Basile C, Lomonte C, Konner K (2011) The arteriovenous fistula: lesser evil or God’s blessing? Blood Purif 32:253
Ladenheim ED, Krauthammer JP, Burnett J, Dunaway T, Parvez S (2014) Liposuction for superficialization of deep veins after creation of arteriovenous fistulas. J Vasc Access 15(5):358–363
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
The manuscript has not been submitted to more than one journal for simultaneous consideration. The manuscript has not been published previously (partly or in full). The study is not split up into several parts to increase the quantity of submissions and submitted to various journals or to one journal over time. No data, text, or theories by others are presented as if they were the author’s own.
Rights and permissions
About this article
Cite this article
Pirozzi, N., Medina, J.G. & Menè, P. Impaired maturation of distal radio-cephalic fistula for haemodialysis: a review of treatment options. J Nephrol 30, 45–51 (2017). https://doi.org/10.1007/s40620-016-0332-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40620-016-0332-3