ArticleVascular health and risk management2026
Peri-Operative Surgical and Anaesthetic Predictors of Autogenous Arteriovenous Fistula (AVF) Maturation: A Retrospective Cohort Analysis.
Article in Vascular health and risk management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The maturation of autogenous arteriovenous fistulas (AVFs) remains unpredictable despite being the preferred vascular access for haemodialysis. Early identification of at-risk AVFs could improve outcomes and reduce unnecessary interventions. The 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a volume flow (Qa) threshold of >500 mL/min, replacing the 2006 >600 mL/min benchmark, as a marker of fistula health. This study evaluates whether perioperative and follow-up Qa measurements are associated with AVF maturation, with particular focus on pre-operative and immediate post-operative Qa, which remain underexplored. The influence of anaesthetic and demographic factors was also assessed. Methods: This single-centre retrospective cohort study included 31 patients undergoing AVF creation. Inflow artery Qa was measured pre-operatively, immediately post-operatively, and at follow-up. Demographics, comorbidities, anaesthetic parameters, and AVF characteristics were obtained from clinical records. Successful maturation was defined as Qa ≥500 mL/min on duplex ultrasound at six weeks and the ability to sustain dialysis (two-needle access for ≥ two-thirds of sessions in the first month without functional concerns). Results: Of 31 AVFs created, 22 (71%) matured by follow-up, either directly (n = 15, median Qa 1050 mL/min) or after fistuloplasty (n = 7, median Qa 800 mL/min). Nine (29%) failed to mature of which six did not undergo fistuloplasty (median Qa 270 mL/min), and three failed despite fistuloplasty (median Qa 332 mL/min). Successful AVFs demonstrated higher median Qa pre-operatively (91 vs 70 mL/min, p = 0.08), post-operatively (495 vs 234 mL/min, p = 0.02), and at follow-up (925 vs 280 mL/min, p < 0.001). The majority of AVF with Qa >700 mL/min at follow-up matured (OR 22.17, 95% CI 3.25-151.3, p = 0.002). No significant associations were found with age, smoking, diabetes, or anaesthetic factors. Conclusion: Perioperative Qa measurement is a practical, low-cost predictor of AVF maturation. The >500 mL/min Qa threshold supports current KDOQI guidance. Pre-operative Qa differences represent a promising area for future research, while demographic and anaesthetic factors showed limited predictive value.
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