Expansion of Blood Volume Increases the Primary Patency Rate of Arteriovenous Fistulas for Hemodialysis in Patients With Critical Arterial Quality

Abstract

The aim of our prospective study was to find out if the expansion of blood volume can improve early arteriovenous fistula (AVF) function after construction in patients with marginal vessel quality. Before AVF construction, the arteries of the upper arm were examined by duplex sonography. Patients with critical values of internal artery diameter (IDA) <1.6 mm, resistance index (RI) at reactive hyperemia (RH) >0.7 and feeding artery blood flow (ABF) <24 mL/min were divided into two groups by random sampling. One group received plasma expander (hydroxyethyl starch) during surgery and the other did not. During the surgical procedures to construct 43 AVFs in 37 patients with critical artery quality, the patients received a mean volume of 720 mL (range 320-1000 mL) of plasma expander. The primary patency rate in this group was 86% (37/43). In the other group of 37 patients with critical artery quality, 42 AVFs were constructed and no plasma expander was given during surgery. The primary patency rate was 26.2% (11/42, P > 0.001). The two-year survival of the AVF in the group given plasma expander was 66.3%, and in the other group it was 13.3%. In our study, the infusion of plasma expander in patients with critical artery quality increased the primary patency rate after AVF construction. Based on the morphological and functional characteristics of arteries determined by pre-operative duplex sonography, the need for blood volume expansion could be predicted.