First-week Postoperative Flow Measurements are Highly Predictive of Primary Patency of Radiocephalic Arteriovenous Fistulas

Abstract

Purpose

This study was conducted to determine whether volume flow rate at the first postoperative visit could predict early failure of radiocephalic arteriovenous fistulas (RCAVFs).

Methods

We retrospectively studied the records of 264 patients who received a RCAVF between 2007 and 2013 at our centers. Data collected included patient demographics, medical history, arterial and venous mapping, and volume flow rate intraoperatively after fistula creation but before closing the surgical incision. An intraoperative flow rate >100 mL/minute was targeted. We measured volume flow at the first postoperative visit 1 week after surgery and thereafter as needed.

Results

Intraoperative flow was not a significant predictor of primary patency (p = 0.44) but flow at the first postoperative visit was a statistically significant predictor of fistula primary patency (p = 0.002). No fistula with a blood flow <200 mL/minute at the 1-week postoperative visit reached maturity without receiving a maturation procedure. The hazard ratio for the first follow-up flow (mL/min) was 0.9973 (95% CI 0.9956, 0.9989), indicating that for every 100 mL increase in blood flow the primary patency increases by 10%.

Conclusions

Flow rate at the 1-week postoperative visit was the most important predictor of RCAVF patency. Thus, it should be possible to identify patients who would benefit from early intervention or closer follow-up as soon as the first postoperative visit. This should help reduce the use of bridging hemodialysis catheters and minimize the risks of catheter dependency.