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Relationship between Vessel Diameter and Time to Maturation of Arteriovenous Fistula for Hemodialysis Access

DOI: 10.1155/2012/942950

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Introduction. Native arteriovenous fistula (AVF) is the recommended vascular access for HD patients by the Dialysis Outcomes Quality Initiative (DOQI) guidelines. The aim of our study was to determine the correlation between diameter and maturation of vessels in radiocephalic AVF. Methods. A prospective cross-sectional study carried out during 2006-2007 on 96 hemodialysis patients from Hasheminejad Kidney Center with non probability selection, all of them with end to side native AVF. Results. In this population 62.5% had wrist (distal radial artery) AVF and 37.5% had antecubital (proximal radial artery) AVF. The mean diameter of artery was 2.57?mm (SD = 1.09) and the mean diameter of vein was 2.40?mm (SD = 0.79). The mean of maturation period was 38.60 days (SD = 42.13). There were no relationship between duration of maturation period and diabetes mellitus, sex, age, diameter of vein and artery ( ). Period of maturation showed some correlation with the diameter of vein ( ) in patients with distal radiocephalic fistulae. Conclusions. The maturation of fistula shows correlation with vein diameter, but no correlation was seen with diameter of the arteries. There is much discrepancy between times to maturation in various reports. The average time for fistula maturation was 38/6 days in our study. 1. Introduction Surgery for hemodialysis (HD) access is the most commonly performed vascular surgical operation in the United States, predominantly because of a steady increase in the prevalence of end-stage renal disease (ESRD) [1]. Native arteriovenous fistula (AVF) is the recommended vascular access for HD patients by the Dialysis Outcomes Quality Initiative (DOQI) guidelines. The current national kidney foundation (DOQI) guidelines endorse this practice and recommend that initial cannulation be delayed for at least four weeks following surgery [2]. A fistula is considered mature when it can achieve a 300?mL/min dialysis blood flow within 1–6 months of its creation. Failure to mature (primary failure) is defined as the inability to meet this goal. Native AVF composed only 17% of all initial permanent hemodialysis access procedures performed in Medicare patients from 1996 to 1997 [3]. In 2002, the dialysis outcomes and practice patterns study (DOPPS) [2], one of the largest prospective observational studies published on hemodialysis practices and outcome in 309 international dialysis facilities, reported that AVF accounted for 24% of all access procedures in the United States, compared with 80% in Europe [4]. Gold standard for AVF maturation is the clinical


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