Clinical Utility of a New Predicting Score for Radiocephalic Arteriovenous Fistula Survival

Abstract

Radiocephalic arteriovenous fistula (RC-AVF) is the recommended first choice for vascular access (VA). The CAVeA2T2 scoring system was recently published (ipsilateral central venous catheter access, age >73years, vein <2.2mm, lower limb angioplasty, and absent intraoperative thrill). The aim of the present study was to assess the clinical utility of the CAVeA2T2 scoring system for predicting RC-AVFs survival in our center and its subsequent application in VA management. In this single-center retrospective study, all RC-AVFs performed from January 2010 to July 2014 were included. The CAVeA2T2 was applied. Primary, assisted primary, and secondary patency rates were measured. Sixty RC-AVFs were analyzed. Mean age was 64.3±14.7years. Mean CAVeA2T2 score was 1.23±1.2. The median fistula secondary patency was 13.7±1.6months. Secondary patency was at 6weeks and at 6, 12, and 24months: 88.3%, 66.7%, 55%, and 31.7%, respectively. Increasing score (≥2) was associated with a decrease in primary (log-rank, χ2 = 16.7, dif= 1, P=0.0001) and secondary patency rate survival (log-rank, χ2 = 5.4, dif = 1, P=0.0001). In addition, stratification of the CAVeA2T2 score into 3 groups (scores 0-1, 2, and 3+) retained its significance for primary (log-rank, χ2 = 19.4, dif = 2, P=0.0001) and secondary patency rate survival (log-rank, χ2 = 5.5, dif = 2, P=0.046) at the end of the study. In the present study, the CAVeA2T2 scoring system has proved to be a useful, easy to apply tool that is highly predictive of RC-AVF survival. Based on our results, we should avoid perform RC-AVFs, in those patients with CAVeA2T2 score ≥2 and late nephrology referral. Prospective studies should be designed to establish the management of patients with a higher CAVeA2T2 score.