Published in the Journal of Vascular Surgery (JVS), new research by Theodore H Yuo (University of Pittsburgh Medical Center, Pittsburgh, USA) and others has drawn a favourable comparison on maturation rates between endovascular arteriovenous fistulas (endoAVF) and surgical AVF (sAVF). Finding them comparable, the study does, however, suggest further interventions and patient selection may play a role in elevating endoAVFs’ maturation rates.
The study authors explain in their abstract that their text reports “our experience with [endoAVF] in comparison to a contemporaneous sAVF group”. The single-centre study was a retrospective one, examining data from 51 recipients of endoAVF procedures alongside those from 51 randomly selected sAVF patients during the period 2018–2022. Outcomes of interest included procedural success rate, number of maturation procedures required and fistula maturation rates. Maturation was defined as successful use of the fistula for haemodialysis in those receiving that treatment or, if a patient was not on haemodialysis, then it was designated as when ≧500 ml/min superficial venous outflow was recorded in endoAVF, or according to clinical criteria in sAVF.
Procedural success was achieved for 98% (50) of the endoAVF patients, though there was a higher rate of reintervention in these patients in the categories of fistula angioplasty (60% vs. 29% for sAVF; p=0.002), ligation (24% vs. 2%; p=0.001) and embolisation of competing outflow veins (22% vs. 2%; p=0.002). Those who received a surgical fistula, meanwhile, underwent planned transpositions more frequently (39% vs. 6%; p<0.001).
With all maturation interventions combined, there was a higher overall rate of maturation procedures for the endoAVF cohort, though the authors note that this was not statistically significant (76% vs. 53%; p=0.692). However, they also set out that the exclusion of planned second-stage transpositions yields a statistically significant higher rate of maturation procedures in this group (74% vs. 24%; p<0.001). Yuo and colleagues also looked at catheter removal, with 15 patients (58%) undergoing it in the endoAVF group and 18 (45%) in the sAVF group (p=0.314). It was additionally found that endoAVF patients were more often male (78% vs. 57%; p=0.033) and were less likely to have congestive heart failure (10% vs. 43%; p<0.001).
Yuo et al state finally that endoAVF maturation rates “appear to be similar” to those of sAVF but, based on their interpretation of their data, caveat that endoAVF’s rates “may be related to higher intensity of maturation procedures and patient selection”. In light of their findings, the researchers note: “An analysis of appropriately matched patients will assist in elucidating the possible role of [endoAVF] vis-a-vis sAVF.”