Annals of vascular surgery · 2026
Intraoperative Optimization of Radiocephalic Arteriovenous Fistula Surgery with Contemporary Techniques.
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White Nicholas A, de Winter Eduard P, Bulder Ruth Ma, Urlings Thijs Aj, van der Steenhoven Timothy J, Eefting Daniel, de Jong Willem Jan, Specken-Welleweerd Janna C, Nadery Laima Siddiqi, Oliveira-Martens Suzanne, Rotmans Joris I, van der Bogt Koen Ea
Аннотация
BACKGROUND: This retrospective study assesses the impact of a standardized intraoperative procedure on radiocephalic arteriovenous fistula (RCAVF) outcomes, combining Transit Time Flow Measurement, papaverine administration, and an external support device.
METHODS: Consecutive RCAVF patients were included at The Hague Medical Center between November 2021 and October 2024. Intraoperative flow rates, maturation rates, and (assisted) patency rates at 6 and 12 weeks, and 6 and 12 months were compared to a contemporary control group from the same center. Maturation was defined as a venous diameter ≥ 4 mm, a flow ≥ 500 mL/min, and a palpable thrill. The number of interventions and per-patient costs of interventions and procedures were also recorded and compared.
RESULTS: The study compared 43 patients in the intervention group with 59 in a control group. The optimized procedure significantly improved intraoperative flow rates (210 ± 89 mL/min vs. 163 ± 85 mL/min, P = 0.008) and maturation rates at 6 weeks (77% vs. 43%, P = 0.002) and 12 weeks (91% vs. 59%, P = 0.003). Males showed higher overall maturation rates (66% vs. 38%, P = 0.030). However, no significant differences were found in primary patency at 12 months, nor in the average number of interventions per patient. There was a trend toward better assisted patency in the optimized procedure group at 12 months. The intervention group had significantly higher average costs per patient (€5858.77 vs. €4148.89, P = 0.002).
CONCLUSION: The optimized RCAVF procedure enhances intraoperative flow and early maturation rates, with the most notable effects in the initial postoperative months. Further research is needed to determine the long-term benefits and cost-effectiveness.
METHODS: Consecutive RCAVF patients were included at The Hague Medical Center between November 2021 and October 2024. Intraoperative flow rates, maturation rates, and (assisted) patency rates at 6 and 12 weeks, and 6 and 12 months were compared to a contemporary control group from the same center. Maturation was defined as a venous diameter ≥ 4 mm, a flow ≥ 500 mL/min, and a palpable thrill. The number of interventions and per-patient costs of interventions and procedures were also recorded and compared.
RESULTS: The study compared 43 patients in the intervention group with 59 in a control group. The optimized procedure significantly improved intraoperative flow rates (210 ± 89 mL/min vs. 163 ± 85 mL/min, P = 0.008) and maturation rates at 6 weeks (77% vs. 43%, P = 0.002) and 12 weeks (91% vs. 59%, P = 0.003). Males showed higher overall maturation rates (66% vs. 38%, P = 0.030). However, no significant differences were found in primary patency at 12 months, nor in the average number of interventions per patient. There was a trend toward better assisted patency in the optimized procedure group at 12 months. The intervention group had significantly higher average costs per patient (€5858.77 vs. €4148.89, P = 0.002).
CONCLUSION: The optimized RCAVF procedure enhances intraoperative flow and early maturation rates, with the most notable effects in the initial postoperative months. Further research is needed to determine the long-term benefits and cost-effectiveness.