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Patients referred for arteriovenous fistula construction: a retrospective outcome analysis

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

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.

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Abbreviations

AVF:

Arteriovenous fistula

AVG:

Arteriovenous graft

BCAVF:

Brachiocephalic AVF

CKD:

Chronic kidney disease

CVC:

Central venous catheter

HD:

Hemodialysis

KDOQI:

Kidney Disease Outcomes Quality Initiative

RCAVF:

Radiocephalic AVF

RRT:

Renal replacement therapy

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Authors and Affiliations

  1. School of Medicine, University College Cork, Cork, Republic of Ireland

    Andrew S. Kucey, Gregory J. Fulton, William D. Plant & Brian J. Manning

  2. Department of Vascular Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland

    Doireann P. Joyce, Gregory J. Fulton & Brian J. Manning

  3. Department of Renal Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland

    Teresa O’Neill & William D. Plant

Authors
  1. Andrew S. Kucey
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  2. Doireann P. Joyce
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  3. Teresa O’Neill
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Correspondence to Andrew S. Kucey.

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The Clinical Research Ethics Committee at University College Cork approved the methods of the current study.

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Kucey, A.S., Joyce, D.P., O’Neill, T. et al. Patients referred for arteriovenous fistula construction: a retrospective outcome analysis. Ir J Med Sci 189, 685–691 (2020). https://doi.org/10.1007/s11845-019-02090-9

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  • DOI: https://doi.org/10.1007/s11845-019-02090-9

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