TY - JOUR
T1 - Epidemiology and Blood Flow Surveillance of the Native Arteriovenous Fistula: A Review of the Recent Literature
AU - Polkinghorne, Kevan R
AU - Kerr, Peter
PY - 2003
Y1 - 2003
N2 - Vascular access placement is a key management issue
for hemodialysis patients. Despite being well regarded
as the access of first choice, the native arteriovenous fistula
(AVF) remains underutilized in the United States. The
first part of this review examines recent epidemiology
studies addressing patient factors associated with the use
of the synthetic arteriovenous graft as opposed to the native
fistula. Female gender and older age are consistently
associated with a higher frequency of graft use. Diabetes,
peripheral vascular disease, and body mass index were
associated with graft use in some but not all of the studies.
Recent evidence also suggests an independent survival
advantage for patients dialyzing via native fistulae
especially for infection-related mortality. The second part
reviews evidence surrounding the recommendations for
blood flow surveillance of the native fistula. The hemodynamic
features of the native fistula are examined and
differences from synthetic grafts are highlighted. Clinical
studies assessing the use of blood flow surveillance to
prevent the sudden thrombosis of native fistulae are
reviewed. Blood flow thresholds for further investigation
are yet to be determined definitely for AVF and randomized
studies should be performed to assesses the impact on
AVF thrombosis rates.
AB - Vascular access placement is a key management issue
for hemodialysis patients. Despite being well regarded
as the access of first choice, the native arteriovenous fistula
(AVF) remains underutilized in the United States. The
first part of this review examines recent epidemiology
studies addressing patient factors associated with the use
of the synthetic arteriovenous graft as opposed to the native
fistula. Female gender and older age are consistently
associated with a higher frequency of graft use. Diabetes,
peripheral vascular disease, and body mass index were
associated with graft use in some but not all of the studies.
Recent evidence also suggests an independent survival
advantage for patients dialyzing via native fistulae
especially for infection-related mortality. The second part
reviews evidence surrounding the recommendations for
blood flow surveillance of the native fistula. The hemodynamic
features of the native fistula are examined and
differences from synthetic grafts are highlighted. Clinical
studies assessing the use of blood flow surveillance to
prevent the sudden thrombosis of native fistulae are
reviewed. Blood flow thresholds for further investigation
are yet to be determined definitely for AVF and randomized
studies should be performed to assesses the impact on
AVF thrombosis rates.
U2 - 10.1046/j.1492-7535.2003.00039.x
DO - 10.1046/j.1492-7535.2003.00039.x
M3 - Article
SN - 1492-7535
VL - 7
SP - 209
EP - 215
JO - Hemodialysis International
JF - Hemodialysis International
IS - 3
ER -