• Muhammad Jamil
  • Rashid Usman


Background: Successful arteriovenous fistula (AVF) significantly reduces both the morbidity as well as mortality of the patients who have end stage renal disease, and significantly improve their survival rate. The objective of the study was to high light the role of various parameters in the functional maturation of arteriovenous fistula (AVF). Methods: This descriptive analytical study conducted at Department of Vascular Surgery, Combined Military Hospital Lahore from January 2014 to January 2015. All consecutive patients who underwent creation of AVF and had pre and post-operative Duplex scan to assess the arteries and veins of the upper limbs, were included. The AVFs were created at wrist, forearm and arm under local anaesthesia. The data was collected from radiology department and dialysis centre and correlated with the data from operation theatre. Results: A total of 127 patients (89 males and 38 females) were included in this study. Only 57.5% (n=73) patients showed functional maturation of their AVFs. Of these, only 14 (36.8%) were females. Arterial and venous diameters of more than 2.5 mm (p=0.0001 and 0.001 respectively), fistulae created at elbow (p=0.001), presence of on-table thrill (p=0.003), presence of on-table bruit (p=0.001), patients having their AVFs created before the start of dialysis (p=0.0037) and kidney transplant (p=0.0042) were all positive predictors for successful functional maturation of AVFs. Female gender was a negative predictor and was responsible for non-maturation (p-value 0.003). Conclusion: Maturation of AVFs is a complex process influenced by a lot of factors. Although in our study various parameters proved to have positive impact on AVFs maturation, large prospective multi-centre studies are needed to provide well defined outcome.


1. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275(20):1089–92.

Barnett SM, Waters WC 3rd, Lowance DC, Rosenbaum BJ. The basilic vein fistula for vascular access. Trans Am Soc Artif Intern Organs 1979;25:344–6.

Arroyo MR, Sideman MJ, Spergel L, Jennings WC. Primary and staged transposition arteriovenous fistulas. J Vasc Surg 2008;47(6):1279–83.

Schild AF, Perez E, Gillaspie E, Seaver C, Livingstone J, Thibonnier A. Arteriovenous fistulae vs. arteriovenous grafts: a retrospective review of 1,700 consecutive vascular access cases. J Vasc Access 2008;9(4):231–5.

Frankel A. Temporary access and central venous catheters. Eur J Vasc Endovasc Surg 2006;31(4):417–22.

Amorim P, Sousa G, Vieira J, Sousa L, Ribeiro K, Sobrinho G, et al. [Complications of vascular access for hemodialysis—Limits, imagination and commitment]. Rev Port Cir Cardiotorac Vasc 2013;20(4):211–9.

Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002;62(4):1109–24.

Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003;63(1):323–30.

Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int 2005;67(6):2462–9.

Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL. Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. Am J Kidney Dis 2004;44(5 Suppl 2):22–6.

Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E,Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002;61(1):305–16.

Allon M, Lockhart ME, Lilly RZ, Gallichio MH, Young CJ, Barker J, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001;60(5):2013–20.

Oliver MJ, McCann RL, Indridason OS, Butterly DW, Schwab SJ. Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int 2001;60(4):1532–9.

Trodior JH, Rooyens P, Dammers R, Van Der Sande FM, de Haan M, Yo TI. Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis. Nephrol Dial Transplant 2003;18(2):378–83.

Feldman HI, Joffe M, Rosas SE, Burns JE, Knauss J, Brayman K. Predictors of successful arteriovenous fistula maturation. Am J Kidney Dis 2003;42(5):1000–12.

Conte MS, Nugent HM, Gaccione P, Roy-Chaudhury P, Lawson JH. Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling. J Vasc Surg 2011;54(5):1383–9.

Salmela B, Hartman J, Peltonen S, Albäck A,, Lassila R. Thrombophilia and arteriovenous fistula survival in ESRD. Clin J Am Soc Nephrol 2013;8(6):962–8.

Sedlacek M, Teodorescu V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis 2001;38(3):560–4.

Allon M, Litovsky S, Young CJ, Deierhoi MH, Goodman J, Hanaway M, et al. Medial fibrosis, vascular calcification, intimal hyperplasia, and arteriovenous fistula maturation. Am J Kidney Dis 2011;58(3):437–43.

Lee T, Ullah A, Allon M, Succop P, El-Khatib M, Munda R, et al. Decreased cumulative access survival in arteriovenous fistulas requiring interventions to promote maturation. Clin J Am Soc Nephrol 2011;6(3):575–81.

Peterson WJ, Barker J, Allon M. Disparities in fistula maturation persists despite preoperative vascular mapping. Clin J Am Soc Nephrol 2008;3(2):437–41.

Jemcov TK. Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation. J Vasc Access 2013;14(4):356–63.

Ocak G, Rotmans JI, Vossen CY, Rosendaal FR, Krediet RT, Boeschoten EW, et al. Type of arteriovenous vascular access and association with patency and mortality. BMC Nephrol 2013;14:79.

Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 2004;15(2):477–86.

American College of Radiology (ACR); American Institute of Ultrasound in Medicine (AIUM); Society of Radiologists in Ultrasound (SRU) ACR-AIUM-SRU practice guideline for the performance of peripheral arterial ultrasound using color and spectral Doppler. Reston (VA): American College of Radiology (ACR); 2010. p5.

Saharabudhe P, Dighe T, Panse N, Patil S. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis. Indian J Nephrol 2013;23(3):191–5.

Miller VM, Burnett JC Jr. Modulation of NO and endothelin by chronic increases in blood flow in canine femoral arteries. Am J Physiol 1992;263(1 Pt 2):H103–8.

Bashar K, Healy D, Browne LD, Kheirelseid EA, Walsh MT, Moloney MC, et al. Role of infra-red therapy in dialysis arterio-venous fistula maturation and survival: systematic review and meta-analysis. PLoS One 2014;9(8):e104931.

Khavanin Zadeh M, Gholipour F, Hadipour R. The effect of hemoglobin level on arteriovenous fistulasurvival in Iranian hemodialysis patients. J Vasc Access 2008;9(2):133–6.




Most read articles by the same author(s)

1 2 > >>