Program Book - Keck School of Medicine of USC - University of ...

AVF Maturation in Clinical Practice• Assessment of literature is very difficult– Definitions of maturation are diverse– Studies are underpowered– Appropriate controls are lacking– Patient population not standardized• AVF maturation failure rate:– 18 – 53% (Allon M. Kidney Int 2002)– 59.5% (Dember L. JAMA 2008)AVF Maturation in Clinical Practice• Assessment of literature is very difficult– Definitions of maturation are diverse– Studies are underpowered– Appropriate controls are lacking– Patient population not standardized• AVF maturation failure rate:– 18 – 53% (Allon M. Kidney Int 2002)– 59.5% (Dember L. JAMA 2008)• Push to increase the utilization of AVF in the US throughNKF-KDOQI Guidelines and FISTULA FIRST Initiative has ledto increase in maturation failure rates (Patel S. J Vasc Surg 2003;Biuckians A. J Vasc Surg 2008)Factors Associated with AVF Maturation• Clinical factors– AVF location, age, gender, race, diabetes, stroke, dialysisdependence at time of AVF placement• Pathologic factors– Matrix metalloprotease levels, arterial micro-calcification• Pre-operative hemodynamic factors– Vein diameter, artery diameter, routine venous/arterial mapping,venous distensibility, MAP> 90, large-caliber accessory veins• Intra-operative factors– AVF blood flow rates, heparin dose, surgeon experience• Post-operative hemodynamic factors– AVF diameter, AVF flow volume, radial artery resistive index86