Radiocephalic Arteriovenous Fistula Patency and Use
Objective:. We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF). Background:. Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred h...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000199 |
| _version_ | 1827856028616622080 |
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| author | Patrick Heindel, MD Peng Yu, MD, PhD Jessica D. Feliz, MD Dirk M. Hentschel, MD Steven K. Burke, MD Mohammed Al-Omran, MD, MSc Deepak L. Bhatt, MD, MPH Michael Belkin, MD C. Keith Ozaki, MD Mohamad A. Hussain, MD, PhD |
| author_facet | Patrick Heindel, MD Peng Yu, MD, PhD Jessica D. Feliz, MD Dirk M. Hentschel, MD Steven K. Burke, MD Mohammed Al-Omran, MD, MSc Deepak L. Bhatt, MD, MPH Michael Belkin, MD C. Keith Ozaki, MD Mohamad A. Hussain, MD, PhD |
| author_sort | Patrick Heindel, MD |
| collection | DOAJ |
| description | Objective:. We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF).
Background:. Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred hemodialysis (HD) access, yet uncertainty about durability and function present barriers to adoption.
Methods:. Pooled data from the 2014-2019 multicenter randomized-controlled PATENCY-1 and PATENCY-2 trials were analyzed. New RC-AVFs were created in 914 patients, and outcomes were tracked prospectively for 3-years. Cox proportional hazards and Fine-Gray regression models were constructed to explore patient, anatomic, and procedural associations with access patency and use.
Results:. Mean (SD) age was 57 (13) years; 45% were on dialysis at baseline. Kaplan-Meier estimates of 3-year primary, primary-assisted, and secondary patency were 27.6%, 56.4%, and 66.6%, respectively. Cause-specific 1-year cumulative incidence estimates of unassisted and overall RC-AVF use were 46.8% and 66.9%, respectively. Patients with larger baseline cephalic vein diameters had improved primary (per mm, hazard ratio [HR] 0.89, 95% confidence intervals 0.81–0.99), primary-assisted (HR 0.75, 0.64–0.87), and secondary (HR 0.67, 0.57–0.80) patency; and higher rates of unassisted (subdistribution hazard ratio 1.21, 95% confidence intervals 1.02–1.44) and overall RCAVF use (subdistribution hazard ratio 1.26, 1.11–1.45). Similarly, patients not requiring HD at the time of RCAVF creation had better primary, primary-assisted, and secondary patency. Successful RCAVF use occurred at increased rates when accesses were created using regional anesthesia and at higher volume centers.
Conclusions:. These insights can inform patient counseling and guide shared decision-making regarding HD access options when developing an individualized end-stage kidney disease life-plan. |
| first_indexed | 2024-03-12T12:18:54Z |
| format | Article |
| id | doaj.art-9882ae6e3dda4c22b799d842d809199f |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:18:54Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-9882ae6e3dda4c22b799d842d809199f2023-08-30T06:10:24ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-09-0133e19910.1097/AS9.0000000000000199202209000-00019Radiocephalic Arteriovenous Fistula Patency and UsePatrick Heindel, MD0Peng Yu, MD, PhD1Jessica D. Feliz, MD2Dirk M. Hentschel, MD3Steven K. Burke, MD4Mohammed Al-Omran, MD, MSc5Deepak L. Bhatt, MD, MPH6Michael Belkin, MD7C. Keith Ozaki, MD8Mohamad A. Hussain, MD, PhD9From the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAFrom the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAFrom the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA‡ Interventional Nephrology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA§ Akebia Therapeutics, Cambridge, MA∥ Division of Vascular Surgery, University of the Toronto, Toronto, ON, Canada** Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.From the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAFrom the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAFrom the * Divisions of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAObjective:. We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF). Background:. Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred hemodialysis (HD) access, yet uncertainty about durability and function present barriers to adoption. Methods:. Pooled data from the 2014-2019 multicenter randomized-controlled PATENCY-1 and PATENCY-2 trials were analyzed. New RC-AVFs were created in 914 patients, and outcomes were tracked prospectively for 3-years. Cox proportional hazards and Fine-Gray regression models were constructed to explore patient, anatomic, and procedural associations with access patency and use. Results:. Mean (SD) age was 57 (13) years; 45% were on dialysis at baseline. Kaplan-Meier estimates of 3-year primary, primary-assisted, and secondary patency were 27.6%, 56.4%, and 66.6%, respectively. Cause-specific 1-year cumulative incidence estimates of unassisted and overall RC-AVF use were 46.8% and 66.9%, respectively. Patients with larger baseline cephalic vein diameters had improved primary (per mm, hazard ratio [HR] 0.89, 95% confidence intervals 0.81–0.99), primary-assisted (HR 0.75, 0.64–0.87), and secondary (HR 0.67, 0.57–0.80) patency; and higher rates of unassisted (subdistribution hazard ratio 1.21, 95% confidence intervals 1.02–1.44) and overall RCAVF use (subdistribution hazard ratio 1.26, 1.11–1.45). Similarly, patients not requiring HD at the time of RCAVF creation had better primary, primary-assisted, and secondary patency. Successful RCAVF use occurred at increased rates when accesses were created using regional anesthesia and at higher volume centers. Conclusions:. These insights can inform patient counseling and guide shared decision-making regarding HD access options when developing an individualized end-stage kidney disease life-plan.http://journals.lww.com/10.1097/AS9.0000000000000199 |
| spellingShingle | Patrick Heindel, MD Peng Yu, MD, PhD Jessica D. Feliz, MD Dirk M. Hentschel, MD Steven K. Burke, MD Mohammed Al-Omran, MD, MSc Deepak L. Bhatt, MD, MPH Michael Belkin, MD C. Keith Ozaki, MD Mohamad A. Hussain, MD, PhD Radiocephalic Arteriovenous Fistula Patency and Use Annals of Surgery Open |
| title | Radiocephalic Arteriovenous Fistula Patency and Use |
| title_full | Radiocephalic Arteriovenous Fistula Patency and Use |
| title_fullStr | Radiocephalic Arteriovenous Fistula Patency and Use |
| title_full_unstemmed | Radiocephalic Arteriovenous Fistula Patency and Use |
| title_short | Radiocephalic Arteriovenous Fistula Patency and Use |
| title_sort | radiocephalic arteriovenous fistula patency and use |
| url | http://journals.lww.com/10.1097/AS9.0000000000000199 |
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