Hemodialysis Arteriovenous Access Cosmesis Scale (AVACS): A new measure for vascular access

Theodore H Yuo; Charles Y Kim; Dheeraj K Rajan; Vandana D Niyyar; Marianna Murea; Ellen D Dillavou; Peter R Bream Jr; Lesley C Dinwiddie; Stephen E Hohmann; Karen Woo; Tushar Vachharajani; Cynthia Roberts; Christie Gooden; George Wj Wright; Andrew J Hogan; Nicole C Ferko; Erin Kahle; Diana Clynes; Charmaine E Lok

doi:10.1177/11297298221141499

Hemodialysis Arteriovenous Access Cosmesis Scale (AVACS): A new measure for vascular access

J Vasc Access. 2022 Dec 14:11297298221141499. doi: 10.1177/11297298221141499. Online ahead of print.

Authors

Theodore H Yuo¹, Charles Y Kim², Dheeraj K Rajan³, Vandana D Niyyar⁴, Marianna Murea⁵, Ellen D Dillavou⁶, Peter R Bream Jr⁷, Lesley C Dinwiddie⁸, Stephen E Hohmann⁹, Karen Woo¹⁰, Tushar Vachharajani^{11

12}, Cynthia Roberts¹³, Christie Gooden¹⁴, George Wj Wright¹⁵, Andrew J Hogan¹⁵, Nicole C Ferko¹⁵, Erin Kahle¹⁶, Diana Clynes¹⁶, Charmaine E Lok^{17

18}

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
² Division of Interventional Radiology, Duke University Medical Center, Durham, NC, USA.
³ Division of Vascular & Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, ON, Canada.
⁴ Division of Nephrology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
⁶ WakeMed Hospital System, Raleigh, NC, USA.
⁷ Vascular and Interventional Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Vascular Access for Hemodialysis: Education and Research, Cary, NC, USA.
⁹ Texas Vascular Associates, Dallas, TX, USA.
¹⁰ Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
¹² Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
¹³ Renal Research Institute, University of North Carolina at Chapel Hill Nephrology and Hypertension Division, Chapel Hill, NC, USA.
¹⁴ North Texas Dialysis Access Clinic, Medical City Dallas, TX, USA.
¹⁵ EVERSANA, Burlington, ON, Canada.
¹⁶ American Association of Kidney Patients, Tampa, FL, USA.
¹⁷ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁸ Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, ON, Canada.

PMID: 36517942
DOI: 10.1177/11297298221141499

Abstract

Rationale and objective: This study aimed to develop a cosmesis scale to evaluate the cosmetic appearance of hemodialysis (HD) arteriovenous (AV) accesses from the perspective of the patient and clinician, which could be incorporated into clinical trials.

Study design: Using a modified Delphi process, two AV access cosmesis scale (AVACS) components were developed in a four-round Delphi panel consisting of two surveys and two consensus meetings with two rounds of patient consultation.

Setting and participants: The Delphi panel consisted of 15 voting members including five interventional or general nephrologists, five vascular surgeons, three interventional radiologists, and two vascular access nurse coordinators. Four patients experienced with vascular access were involved in patient question development.

Analytical approach: For a component to be included in the AVACS, it had to meet the prespecified panel consensus agreement of ⩾70%.

Results: The clinician component of the AVACS includes nine questions on the following AV access features: scarring, skin discoloration, aneurysm/pseudoaneurysms and megafistula appearance. The patient component includes six questions about future vascular access decisions, interference with work or leisure activities, clothing choices, self-consciousness or attractiveness, emotional impact, and overall appearance.

Limitations: Delphi panel methods are subjective by design, but with expert clinical opinion are used to develop classification systems and outcome measures. The developed scale requires further validation testing but is available for clinical trial use.

Conclusions: While safety and efficacy are the primary concerns when evaluating AV access for HD, cosmesis is an important component of the ESKD patient experience. The AVACS has been designed to assess this important domain; it can be used to facilitate patient care and education about vascular access choice and maintenance. AVACS can also be used to inform future research on developing new techniques for AV access creation and maintenance, particularly as relates to AV access cosmesis.

Keywords: Arteriovenous access; clinician instrument; cosmesis; modified Delphi panel approach; patient satisfaction; questionnaire.

Grants and funding

R01 AG071803/AG/NIA NIH HHS/United States