Arteriovenous Fistula Research Articles

Urgical Challenges In Managing Haemodialysis Arteriovenous Fistula Complications In Tertiary Care Centre: Our Approach.

Arteriovenous (AV) fistula creation is the most common surgical procedure for providing vascular access for haemodialysis in patients with chronic kidney disease (CKD). The functioning of fistula dictates the quality of dialysis and the longevity of patients. The most common circumstances that require surgical takedown of AV fistula are thrombosis and rupture. While some patients undergo elective AV fistula takedown post renal transplantation or for cosmesis, majority of patients presenting with life-threatening rupture require emergency surgery for AV fistula takedown with or without maintaining arterial continuity. This study aims to compile our experience with surgical management of various AF fistula complications. This is a retrospective study of 29 patients who underwent Arteriovenous Fistula takedown in our institute over a period of 3years from May 2021 to May 2024. The most common cause of fistula takedown in our setup was rupture (n=25, 86.21%). AV fistula takedown was done in all cases (n=29, 100%). Arterial ligation was done in all infected cases (n=22, 75.86%) whereas in non-infected cases arterial continuity was maintained by repair or interposition venous graft. There was no aneurysm or psedoaneurysm formation or limb ischaemia in a follow up period ranging from 1month to 3 years. Erroneous ways of cannulation and lack of awareness of fistula care were the prime cause of AV fistula complications. Early detection and presentation to healthcare setup could offer a better prognosis for limb salvage in the long term and decrease the incidence of morbidity and mortality.

Construction and validation of a prediction model for arteriovenous fistula thrombosis in patients with AVF using Lasso regression.

The primary objective of this study is to develop and validate a high-risk model for Arteriovenous Fistula Thrombosis (AVFT) in patients undergoing autogenous arteriovenous fistula surgery for hemodialysis. Retrospectively, we collected general information, clinical characteristics, laboratory examinations, and dialysis-related factors from a cohort of 1465 patients who received continuous arteriovenous fistula surgery at the Hemodialysis Access Center of Sichuan Provincial People's Hospital between January 2019 and June 2022. The patients were randomly divided into a training set and a validation set in a 2:1 ratio. The training set was utilized to select AVFT-related features using LASSO regression. A predictive model was constructed using logistic regression analysis, and its performance was assessed in the validation set. Through LASSO regression, we initially identified 13 candidate factors. Subsequently, based on the Akaike Information Criterion (AIC) principle, the following factors were selected to construct the AVFT prediction model: monocytes_ratio, Fistula blood velocity, cystatin-c, homocysteine, parathormone, artery_dysfunction, C-reactive protein, fibrinogen, and d-dimer. The discrimination C-index of the model in the training set was 0.8767. For this training set, the sensitivity was 48.05% and the specificity was 96.84%. In the validation set, the model's discrimination C-index, as evaluated by the ROC curve analysis, was 0.7888. The sensitivity was 14.29%, and the specificity was 97.04%. We assessed the calibration of the model using calibration curves, obtaining a maximum absolute difference of Emax = 0.205 and an average absolute difference of Eave = 0.032. Furthermore, we evaluated calibration and accuracy using the Spiegelhalter Z-test, yielding an S:P ratio of 0.704. AVFT is a multifactorial outcome influenced by factors such as injury, inflammatory factors, blood glucose levels, blood velocity, coagulation, electrolyte metabolism, and vascular endothelial function.

Creating an Ellipsys percutaneous arteriovenous fistula after a failed ipsilateral WavelinQ fistula: A case report of an endovascular approach for access restoration.

The introduction of devices for endovascular dialysis access creation (WavelinQ and Ellipsys) offers practitioners more options for access management in dialysis patients. Especially in terms of reducing the usage of central venous catheters, a native fistula is desirable as an initial dialysis access. We present a case in which a failed WavelinQ type fistula was reactivated using the Ellipsys procedure on the same arm. This specific rescue method is based on the idea that the proximal part of an endoAVF from an earlier WavelinQ procedure which resulted in adequately dilated veins, comprising the perforating vein, may allow a subsequent Ellipsys procedure. This case report shows how the use of endovascular techniques such as WavelinQ and Ellipsys can be incorporated in a clinical context and create new options for the patient.

Assessment of Arteriovenous Fistula Maturation in Hemodialysis Patients with Persistently Positive Antiphospholipid Antibody: A Prospective Observational Cohort Study

Assessment of Arteriovenous Fistula Maturation in Hemodialysis Patients with Persistently Positive Antiphospholipid Antibody: A Prospective Observational Cohort Study

Effect of Haemodiafiltration Versus Haemodialysis on Vascular Access Patency when Starting Haemodialysis.

Haemodiafiltration (HDF) therapy improves the prognosis by reducing inflammation and oxidative stress, and improving endothelial function. These factors contribute to vascular access (VA) stenosis, one of the most common complications in patients on haemodialysis (HD) or HDF. This study aimed to assess the efficacy of HDF on VA patency. This multicentre, prospective, observational study with post-hoc analysis included 612 patients among 643 who underwent VA procedures and started dialysis between April 2012 and March 2021. Five hundred and sixteen patients were on HD from starting dialysis, while 96 switched to HDF after starting dialysis. One-to-one propensity score matching was performed to compare the 24-month patency rates of VA between groups by Kaplan-Meier and log-rank tests, and a Cox proportional hazard regression analysis was used to identify factors affecting patency rates. There were 87 patients in each group. The 24-month primary patency rates were 74.2% for HDF and 47.7% for HD (P<0.001). A multivariate Cox proportional hazards analysis showed that a history of cardiovascular disease (hazard ratio [HR] 2.29; 95% confidence interval [CI] 1.21-4.34, P=0.01) and higher haemoglobin A1c values (HR 1.37; 95% CI 1.00-1.82, P=0.04) were associated with poor 24-month primary patency. However, HDF (HR 0.30; 95% CI 0.16-0.56, P<0.001) and use of statins (HR 0.50; 95% CI 0.27-0.94, P=0.03) were associated with better patency. A stratified analysis showed that HRs for loss of VA patency were lower in patients with HDF than in those with HD in the subgroups of≥65 years, male sex, radiocephalic arteriovenous fistula, a history of diabetes mellitus or cardiovascular disease, haemoglobin concentrations <10g/dL, and albumin concentrations<3.5g/dL. HDF potentially improves VA patency rates compared with HD, even in patients with cardiovascular disease or diabetes, commonly associated with poor patency.

Long Term Results of a Comparative Study of Percutaneous and Surgically Created Proximal Forearm Arteriovenous Fistulae.

This retrospective, single centre, comparative effectiveness study aimed to compare the long term outcomes of percutaneous arteriovenous fistulae (pAVF) and surgically created arteriovenous fistulae (sAVF) created in the proximal forearm for haemodialysis access. Data were reviewed from a prospectively maintained database on patients who underwent pAVF or sAVF creation from September 2017 to September 2023. A total of 217 pAVFs (61 WavelinQ and 156 Ellipsys) and 158 sAVFs were analysed. Outcome measures included technical success, maturation, patency, time to first successful use, re-interventions, and complications. Technical success was 100% for sAVF and Ellipsys, and 93.4% for WavelinQ (p < .001). Maturation at four weeks was higher in Ellipsys (78.6%) and sAVF (79.7%) groups than in WavelinQ (64.9%) (p = .042). Median time to first cannulation was shortest for Ellipsys (57 days), followed by sAVF (73 days), and longest for WavelinQ (98.6 days) (p = .048). Average follow up was 654 days (interquartile range 164, 1 049 days; range 0 - 2 061 days). Primary patency was higher in sAVF than in pAVFs. The Cox proportional hazard ratio (HR) for loss of primary patency was 1.50 for WavelinQ and 1.42 for Ellipsys compared with sAVF (p = .045). Secondary patency was statistically significantly lower for WavelinQ (HR 2.76; p < .001), but not for Ellipsys (HR 0.74; p = .33). Haemodialysis access induced distal ischaemia (HAIDI) was more common in the sAVF group with nine events (5.7%) compared with one for the Ellipsys (0.64%; p = .008). Re-intervention rates per patient year were comparable across groups (0.60 vs. 0.61 vs. 0.69 for sAVF, WavelinQ, and Ellipsys, respectively). This study indicates that while all access types can provide long term functional haemodialysis access, sAVFs perform better in some outcome domains and pAVFs (particularly Ellipsys) in others, with sAVF showing higher rates of HAIDI, yet lower rates of juxta-anastomotic stenosis. The findings underscore the importance of personalised vascular access planning, weighing immediate procedural outcomes against long term functionality.

Six-month safety and efficacy outcomes from the randomized-controlled arm of the WRAPSODY Arteriovenous Access Efficacy (WAVE) trial.

Stenosis within the arteriovenous fistula (AVF) of hemodialysis patients leads to vascular access dysfunction and inadequate hemodialysis. Percutaneous transluminal angioplasty (PTA) is the standard therapy for stenosis. However, rates of restenosis and loss of access patency remain high. Outcomes of a novel cell-impermeable endoprosthesis (CIE) have not been investigated in this setting. Therefore, our study was designed to address this as a prospective, international, multicenter pivotal trial (NCT04540302) with 245 patients with stenosis in their venous outflow circuit randomized to treatment: 122 receiving CIE and 123 receiving PTA across 43 international centers. Primary endpoints included target lesion primary patency (TLPP) at six months (freedom from clinically driven target lesion revascularization or target lesion thrombosis) and freedom from safety events through 30 days post-index procedure that affected the access circuit and resulted in reintervention, hospitalization, or death. Access circuit primary patency (ACPP) was evaluated as a secondary efficacy endpoint. Six-month TLPP and ACPP were significantly higher for the CIE cohort versus PTA (TLPP: 89.6% vs. 62.3%; ACPP: 72.2% vs. 57.0%). Thirty days post index procedure, there was no statistically significant difference in the freedom from safety events for the CIE versus PTA (96.6 vs. 95.0%). No differences were observed in adverse events between either cohort. Our study shows that among patients with stenosis in their AVF, the CIE was superior to PTA with respect to six-month TLPP and ACPP with no observed difference in 30-day primary safety events.

General Surgery Residents Competence and Autonomy in Core Vascular Surgery Procedures.

As vascular surgery has become increasingly sub-specialized, the scope of vascular care that general surgeons can be trained to provide has come into question. Thus, we sought to understand the competence and autonomy of general surgery residents (GSR) in core vascular surgery procedures. Three core operations in vascular surgery were identified: lower extremity (LE) amputations, arteriovenous fistula (AVF) creation, and LE embolectomy and thrombectomy (thromboembolectomy). Assessment of GSRs autonomy and performance for these operations were obtained from the System for Improving and Measuring Procedural Learning (SIMPL) application from 2018 to 2022. Data were analyzed using a combination of descriptive statics and chi-square tests. Logistic generalized linear mixed models (GLMM) were also performed. 1950 SIMPL operative assessments were analyzed. Senior residents were found to be meaningfully autonomous and competent in 82% (n = 237) and 66% (n = 189) of LE amputation assessments and 50% (n = 225) and 32% (n = 142) of AVF assessments, respectively. The majority of senior residents failed to achieve meaningful autonomy (n = 99, 67%) and competence (n = 116, 80%) for LE thromboembolectomy cases, while the majority of junior and midlevel residents failed to achieve meaningful autonomy and competence for all 3 procedures. For an average case, a senior resident had an 86% (95% CI: 79% - 89%) chance of achieving competence during LE amputation, 41% (95% CI: 43% - 62%) chance during AVF, and 21% (95% CI: 27% - 52%) chance during LE thromboembolectomy. In this study, GSR failed to achieve competence and meaningful autonomy for 3 core procedures, including AVF creation. Notably, the creation of an AVF was recently included within the new Entrustable Professional Activities (EPAs) for general surgery. However, the results of this study suggest that GSR will fail to demonstrate the competence needed for entrustment. Training requirements for general surgery residents in vascular surgery may need to be reassessed.

Comparative outcomes of endovascular vs. surgical treatment in craniocervical junction dural arteriovenous fistulas: A systematic review and meta-analysis.

Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis. A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. Fifteen studies involving 266 patients were included. Of these, 143 (53.8%) patients underwent surgical treatment alone and 123 (46.2%) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8%. Retreatment rate was 6.2%. Periprocedural complications occurred in 21.6% of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6%. Retreatment rate was 46.7%. Periprocedural complications occurred in 18.8% of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, p=0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p=0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, p<0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms. Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.

Comparative Efficacy and Safety of Endovascular vs. Surgical Treatment in Spinal Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis.

Systematic Review and Meta-analysis. This study aims to compare the efficacy and safety of surgical and endovascular treatments for SDAVFs. Spinal dural arteriovenous fistulas (SDAVFs) result from an abnormal connection between the radiculomeningeal artery and the radicular vein, leading to venous hypertension and potential neurological damage. The two primary treatment strategies are surgical closure and endovascular obliteration of the fistula. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. We defined the successful treatment as fistula occlusion with sufficient embolic material penetration or obliteration during surgery. A total of 1192 articles were identified, with 40 studies meeting the inclusion criteria, comprising 1818 patients (surgical: 804, endovascular: 1014). The surgical group demonstrated higher rates of complete occlusion at last follow-up (96.8%, 363/375) compared to the endovascular group (72.5%, 470/648) (OR: 0.16; CI: 0.09 to 0.28, P<0.01). Surgical treatment also had higher successful treatment rates (97.5%, 392/402) compared to endovascular treatment (66.7%, 529/793) (OR: 0.11; CI: 0.06 to 0.19, P<0.01). Recurrence rates were lower in the surgical group (OR: 6.04; CI: 3.45 to 10.57, P<0.01) and retreatment rates were also lower (OR: 7.16; CI: 4.11 to 12.48, P<0.01). Initial treatment failure was significantly higher in the endovascular group (32.2%, 329/1023) compared to the surgical group (2.3%, 19/804) (OR: 8.97; CI: 5.56 to 14.45, P<0.01). Surgical treatment for SDAVFs achieves higher rates of complete occlusion and successful treatment compared to endovascular treatment, with lower rates of recurrence, retreatment, and initial treatment failure. Although both treatments show similar improvements in neurological status and periprocedural complications, surgery remains the preferred approach for definitive results. Treatment decisions should be individualized based on patient-specific factors and anatomical characteristics. Further research is needed to confirm these results.

Three-Dimensionally Printed Self-Expanding Polylactic Acid Stent for Assisting Arteriovenous Fistula Maturation

Three-Dimensionally Printed Self-Expanding Polylactic Acid Stent for Assisting Arteriovenous Fistula Maturation

Maximizing use of available vascular capital for autologous arteriovenous fistula creation and maintenance: Single center results.

Nicaragua is a Central American country with a high prevalence of patients with chronic kidney disease, particularly among young men. This is largely attributable to Mesoamerican nephropathy, a form of interstitial nephritis that predominantly affects young agricultural workers. While the majority of patients have access to chronic dialysis programs, a very small number have an option of receiving a renal transplant. Consequently, they must spend years on hemodialysis (HD), where the vascular access issue is of vital importance for their survival. Given that prosthetic arteriovenous grafts (AVG) are expensive devices with a lower cost-benefit ratio, limited availability within the health system and are unaffordable for the majority of patients, it is crucial to perform autogenic arteriovenous fistula (AVF) whenever possible. This paper presents a 4-year period review (2020-2023) of a single-center vascular access program that optimizes vasculature utilization of each patient for creation of AFV and describes the surgical revision techniques used to prolong the patency of vascular accesses. The autogenic vascular access program has resulted in more than 80% of prevalent patients undergoing HD at our center being hemodialyzed through an autogenic AVF by the end of 2023. It can be concluded that it is possible to significantly increase the proportion of autogenic vascular accesses in each center by optimizing the patient's own vasculature. This approach has the potential to reduce morbidity and costs, particularly in low-income countries.

Moroccan Adaptation of the 'Self-Care Behaviour Assessment Scale' for Arteriovenous Fistula in Haemodialysis.

Arteriovenous fistula self-care behaviours in patients receiving haemodialysis are essential to maintain patency of vascular access and prevent its life-threatening complications. Assessing arteriovenous fistula self-care behaviours in patients receiving haemodialysis requires a reliable and valid tool. The aim of this study was to adapt and translate the Portuguese scale for the assessment of self-care behaviours of arteriovenous fistula in patients receiving haemodialysis into the Moroccan dialect and evaluate its psychometric properties in the Moroccan context. A quantitative cross-sectional validation study. This study included 283 patients undergoing haemodialysis with arteriovenous fistula in the Marrakech-Safi region of Morocco. The translation was performed in accordance with international guidelines. Instrument validity was assessed using content validity and factor analysis with Varimax rotation for construct validity. Instrument reliability was assessed by measuring internal consistency using Cronbach's α. Content validity was assessed by a panel of experts. The Kaiser-Meyer-Olkin score of 0.885 justified data adaptation for factorial analysis. Bartlett's sphericity test confirmed the existence of significant relationships (chi-square = 1347.328; p < 0.001). A two-factor structure was extracted, explaining 50.85% of the total variance. Cronbach's α was 0.892, 0.853 and 0.752 for the overall scale, the self-care subscale for managing signs and symptoms and the self-care subscale for preventing complications, respectively. The Moroccan version of the Self-Care Behaviour Assessment Scale for Arteriovenous Fistula is a reliable and valid instrument for future studies evaluating the self-care behaviours of patients receiving haemodialysis with an arteriovenous fistula in Morocco.

Assessing the risk of drug-induced dural arteriovenous fistulas

Assessing the risk of drug-induced dural arteriovenous fistulas

An iliac arteriovenous fistula associated with leg swelling 2 years after the removal of a hemodialysis catheter: A case report.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis. In rare instances, this procedure can result in a very serious complication known as arteriovenous fistula (AVF). Although some cases of femoral arteriovenous fistula have been reported previously in the literature; however, the incidence of iliac AVF precipitated by a hemodialysis catheter is exceedingly uncommon. The purpose of this study is to report a case in which a hemodialysis catheter caused a femoral arteriovenous fistula and to describe the successful treatment, thereby providing a reference for the diagnosis and treatment of such conditions in the future. Herein, we report the case of a patient with diabetes and end-stage kidney disease (ESKD) who presented with an iliac arteriovenous fistula as a complication of hemodialysis catheter insertion into the right femoral vein. Two years after hemodialysis catheter removal, the patient was admitted to our institution with swelling of the right lower limb and calf pain. The patient was subsequently diagnosed with an iliac arteriovenous fistula by computed tomography angiography and angiography. The patient was transferred to the Vascular Surgery Department for surgical treatment. The patient's leg swelling improved after surgery. After 1 year of follow-up, there was no occurrence of swelling in the patient's right leg. If the patient has a history of femoral venous catheter placement and develops limb swelling, in addition to considering the presence of a femoral arteriovenous fistula, it is important to consider the possibility of an iliac AVF. Iliac AVF are rare disorders. The primary goal for treatment of IAVF is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective for the treatment of iliac AVF. Iliac AVFs are rare disorders. The primary goal of treatment for iliac AVFs is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective in the treatment of iliac AVFs.

Use of vascular access methods for hemodialysis in Serbia: Results from SerbVasc registry.

In many countries, hemodialysis is still the most common method of renal replacement. Significant regional variations exist in creating and maintaining vascular access for hemodialysis. Therefore, analyzing national registries with vascular access data is essential for developing effective national treatment strategies. The Serbian national vascular surgery registry was established as part of the VascuNet collaboration network in 2019. The registry comprehensively records vascular procedures across Serbia, including those related to vascular access for hemodialysis. This study aims to evaluate the prevalence of different vascular access methods for hemodialysis in Serbia, focusing on both new and prevalent patients and examining demographic differences and risk factors. The data were collected from the vascular accesses section of the SerbVasc registry over a 3-year observational period, focusing on the following aspects: number of incident and prevalent patients with types of vascular access, as well as comparison of patients with arteriovenous fistulas (AVF), arteriovenous grafts (AVG), central venous catheters (CVC), and tCVC based on age, gender, smoking, and comorbidities. There were total of 1024 incident hemodialysis patients. AVF was created in 219 patients (21.4%), AVG in 5 patients (0.5%), and tCVC in 150 patients (14.6%), while hemodialysis via CVC was initiated in 650 (63.5%) patients. The total number of permanent vascular accesses for HD was 1402, comprising 686 (48.9%) distal AFVs, 220 (15.7%) proximal AVFs, 91 (6.4%) AVGs, and 405 (28.8%) tCVCs. The prevalence of current smoking was highest in the tCVC (48.3%) and lowest in the dAVF group (18.40%). The percentage of patients starting hemodialysis with AVF remains suboptimal. tCVC is used substantially as first and permanent access, particularly among older patients.

Safety of pre-operative venogram for hemodialysis access planning in pre-end-stage kidney disease patients.

Although conventional pre-operative venography can accurately delineate venous anatomy as an alternative to ultrasound for hemodialysis access planning, it may carry a risk of contrast-induced acute kidney injury (AKI) and progression of renal failure in chronic kidney disease (CKD) patients not yet on dialysis. Therefore, the objective of this study was to evaluate the safety and efficacy of pre-operative venograms in pre-end-stage kidney disease (ESKD) patients. We performed a retrospective cohort study (2018-2022) of consecutive pre-ESKD patients who underwent staged bilateral venograms for preoperative vein mapping prior to hemodialysis access creation at a tertiary care medical center. Patients were identified through an institutional database and data were extracted with chart review adjudication. The primary safety outcome was a composite of unplanned dialysis initiation within 7 days of venogram or development of contrast-induced AKI. Secondary outcomes included vascular access creation within 1 year of index venogram. A total of 142 pre-ESKD patients underwent 284 venograms. Mean (SD) age was 67 (14) years; 55% were female; and 65% of patients had stage 5 CKD, whereas 35% had stage 3 or 4 CKD. Rate of the primary safety outcome was 2.5%, which was driven by a 2.5% rate of contrast-induced AKI with no instances of unplanned dialysis initiation within 7 days of either venogram. Ultimately, 120 (85%) vascular accesses were created, of which 96% were autogenous fistulas. Forearm arteriovenous fistulas (AVFs) were the most common configuration (69%) followed by upper arm AVFs (27%); AV grafts were created in 4% of cases. In a population of pre-ESKD patients, staged bilateral venograms led to few cases of reversible contrast-induced AKI with no instances of unplanned dialysis initiation. Furthermore, access creation was achieved in 85% of patients with the majority consisting of forearm AVFs. Therefore, preoperative venography for access planning appears safe in pre-ESKD patients.

Cardiac complications of arteriovenous access: a narrative review from a multidisciplinary team perspective

Although cardiovascular disease is common among hemodialysis patients, arteriovenous access creation has been invariably implicated in the evolution of adverse cardiac outcomes or deterioration of pre-existing cardiovascular disease. In most cases, these effects are subclinical but with potential underlying echocardiographic findings. Compared with grafts, arteriovenous fistulas are implicated more often, due to the progressively increased flow from the continuous dilatation of the venous outflow tract in the long term. The increasing flow is in the majority of patients well tolerated by cardiac adaptive alterations. However, the clinical impact is based on the balance between the amount of flow volume and the patient’s cardiac reserves. Having extensively reviewed the existing English literature, we present the pathophysiology and the different types of cardiovascular complications, the indications, types, and efficacy of flow-restrictive procedures in the context of a high-flow AVF, as well as some precautions and considerations for AVF creation in high-risk patients.

Elevated Interleukin-6 Is Associated with an Increased Risk of Long-Term Arteriovenous Fistula Failure for Dialysis.

Background/Objectives: The autologous arteriovenous fistula (AVF) is the preferred choice for vascular access in patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis. However, in the long term, the primary patency of AVF is suboptimal, with an AVF failure of approximately 30% in one year. The aim of this study is to examine how the pre-operative baseline levels of interleukin-6 (IL-6) affect long-term AVF failure. Methods: This retrospective, observational study involves ESKD patients admitted to the Vascular Surgery Clinic for AVF creation from January 2020 to December 2023. Ultimately, a total of 91 patients whose AVFs matured and began dialysis were enrolled. Prior to surgery, each patient underwent a thorough blood sample collection, with IL-6 levels assessed. The patients were categorized into two groups: those with functioning AVFs and those with dysfunctional AVFs. Their progress was monitored via a review of medical records, telephone interviews, or direct contact. Following the surgery, patients were observed for an average of 1.53 ± 0.94 years. Results: During the follow-up, patients who experienced AVF failure had a higher incidence of diabetes mellitus (p = 0.019) and active smoking (p = 0.012), as well as higher levels of IL-6 (p < 0.001). At ROC analysis, we found a strong association between IL-6 value and AVF failure (AUC: 0.814, p < 0.001), with an optimal cut-off value of 7.08 (76.5% Sensitivity and 79.7% Specificity). Furthermore, at the survival curve Kaplan-Meier analysis, we observed a higher occurrence of AVF failure in patients with baseline IL-6 values above the median (p = 0.004), in tertile 3 (p = 0.002), and above the optimal cut-off value (p < 0.001). At cox-regression analysis, elevated baseline IL-6 levels are associated with AVF Failure (HR: 2.23, p < 0.001). Conclusions: In the current study, we demonstrated that elevated IL-6 levels at baseline are associated with long-term AVF failure, independent of age, sex, and cardiovascular risk factors.

Antithrombotic therapy impact on patency and bleeding complications of arteriovenous graft placement in dialysis patients.

Background: Arteriovenous grafts (AVG) can be the only bailout solution for patients who require kidney replacement therapy but are unsuitable for arteriovenous fistula (AVF) creation. Currently, high-level evidence on the effectiveness and safety of antithrombotic therapy in AVG patients is scarce. Materials and methods: Following the PICO (patient; intervention; comparator; outcome) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a data search of the English literature in PubMed, SCOPUS, Central Cochrane was conducted, until March 1st, 2023 (PROSPERO Protocol Number: CRD42023401785). Studies on humans with an AVG receiving any kind of antithrombotic medication, reporting on primary and secondary patency rates, and bleeding complications were included. Due to data heterogeneity, a descriptive report of the outcomes was undertaken. Results: Twelve studies, including 22,436 patients with end-stage renal disease (ESRD) and AVG were included, with patient recruitment spanning over a 41-year time-period (1982-2023). Antithrombotic factors included acetylsalicylic acid (ASA), clopidogrel, dipyridamole, warfarin, unfractioned heparin (UFH), and direct oral anticoagulants (DOACs). Ten studies reported on primary patency rates, and two on secondary patency rates. Primary and secondary patency rates (PPR, SPR) were reported better in four studies, similar in three and worse in one study, regarding patients receiving any kind of antiplatelet therapy. Anticoagulation therapy was not associated with increased PPR or SPR, except for one study on apixaban. Patients receiving single or combined antiplatelets versus patients receiving no treatment presented higher bleeding risk in two studies and similar bleeding risk in three studies. Anticoagulation therapy, excluding apixaban, was associated with higher bleeding risk in three studies, when compared to no anticoagulation. Conclusions: Data derived from the current literature were equivocal regarding the use of antiplatelet treatment in patients with AVG. Studies on anticoagulation therapy are confined. Randomized trials with confounder stratification remain crucial for robust long-term data.