Background: Native vein arteriovenous fistulas (AVFs) are the recommended first-line vascular access in hemodialysis patients. Despite this, AVFs are plagued with unfavorable maturation rates. We conducted a retrospective cohort study to assess the AVF success rate and to identify any significant associating factors.
Methodology: Demographic and clinical data of all AVFs created from January 2011 to June 2013 at a single center with a multi-ethnic Asian population, were reviewed. The primary outcome was AVF successfully used for hemodialysis (FUSH) at 6 months. Secondary endpoints were the overall FUSH and actual maturation time of the AVFs. Univariate and multivariate analyses were performed to identify factors associated with AVF success.
Results: A total of 375 fistulas were created during the study period (110 radiocephalic, 176 brachiocephalic, 89 brachiobasilic). The mean age was 59.4 ± 12.6 years and 42.9% were females. Seventy-one percent of patients had diabetes, 32.5% had ischemic heart disease and 10.7% had peripheral vascular disease. 246/375 (65.6%) AVFs FUSH by 6 months, and the average AVF maturation time was 16.1 ± 10.7 weeks. Of the 246 AVFs, 11% required secondary procedure to assist their success. Univariate analysis showed that gender (p = 0.035), age (p = 0.018), vein size on pre-operative vein mapping (p = 0.004) and operating surgeon (p = 0.021) were significant factors associated with AVF success. On multivariate analysis, age, pre-operative vein size and operating surgeon were significantly associated with fistula success.
Conclusions: Reasonable FUSH rates can be achieved in the study patients. Patient age, pre-operative vein mapping size and operating surgeon were shown to influence AVF success rate.