An investigation into factors predicting patency and maturation of arteriovenous fistulae used for haemodialysis in endstage renal disease

• Main Author: Ferring, Martin Michael
• Published: University of Birmingham 2013
• Subjects: 610; R Medicine (General)
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573555

Arteriovenous fistulae (AVF) are the preferred access for haemodialysis in endstage renal disease, but have a considerable failure rate. In this thesis we investigated factors which may affect patency and maturation of new AVF: (1) ethnicity, (2) native vein histology, (3) pre-operative vascular mapping with ultrasound, and (4) post-operative ultrasound of AVF. Ethnicity did not affect AVF outcomes in our large retrospective study, although diabetes was associated with AVF failure and more common among non-Caucasians. Native vein disease, specifically vein media fibrosis, was associated with immediate AVF failure in our small cohort study, possibly reflecting poor vein dilatation. In our randomised trial we showed that routine pre-operative ultrasound mapping of native vessels prior to AVF formation was effective at improving immediate and assisted primary AVF patency. Early post-operative assessment with ultrasound predicted subsequent AVF failure in our cohort study. In conclusion, we recommend routine pre-operative ultrasound vascular mapping to improve AVF outcomes. A randomised prospective trial should be considered to evaluate whether early post-operative ultrasound helps to improve AVF patency. The significance of native vein media fibrosis needs to be confirmed in a larger study.