Autogenous Vascular Access in American Indians.

Arteriovenous Fistula / etiology Arteriovenous Shunt, Surgical / adverse effects Female Graft Occlusion, Vascular / diagnostic imaging Humans Male Middle Aged Obesity / complications Renal Dialysis / adverse effects Retrospective Studies Risk Factors Time Factors Treatment Outcome Vascular Patency American Indian or Alaska Native
AI AVF American Indian Arteriovenous fistula Hemodialysis Native American Vascular access

Journal

Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941

Informations de publication

Date de publication:
Jul 2022
Historique:
received: 11 09 2021
revised: 12 11 2021
accepted: 15 11 2021
pubmed: 27 12 2021
medline: 29 6 2022
entrez: 26 12 2021
Statut: ppublish

Résumé

American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients. Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4-6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm. 235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15-89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04). Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity.

Sections du résumé

BACKGROUND BACKGROUND
American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients.
METHODS METHODS
Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4-6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm.
RESULTS RESULTS
235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15-89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04).
CONCLUSIONS CONCLUSIONS
Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity.

Identifiants

DOI: 10.1016/j.avsg.2021.11.026 PMID: 34954040
pubmed: 34954040
pii: S0890-5096(21)00947-X
doi: 10.1016/j.avsg.2021.11.026
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

108-116

Informations de copyright

Copyright © 2021. Published by Elsevier Inc.

Auteurs

Kelly Kempe (K)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Peter R Nelson (PR)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Nasir Mushtaq (N)

Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK.

Hyein Kim (H)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Kimberly Zamor (K)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Steven Vang (S)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Viraj Pandit (V)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.

Mark Randel (M)

Eastern Oklahoma VA Health Care System, Department of Surgery, OK.

Ryan Christie (R)

University of Oklahoma School of Community Medicine, Tulsa, OK.

William Jennings (W)

Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community, Medicine, Tulsa, OK. Electronic address: william-jennings@outlook.com.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Fistule › Fistule vasculaire › Fistule artérioveineuse › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Greffe vasculaire › Anastomose chirurgicale artérioveineuse › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Occlusion du greffon vasculaire › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Obésité › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Thérapeutique › Détoxication par sorption › Dialyse rénale › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Phénomènes physiques › Temps › Facteurs temps › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Degré de perméabilité vasculaire › Autogenous Vascular Access in American Indians.
questionsmedicales.fr › Personnes › Nord-Américains › Groupes de population aux États-Unis › Populations d'origine continentale › Population d'origine amérindienne › Autogenous Vascular Access in American Indians.