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Bashar, K,Clarke-Moloney, M,Burke, PE,Kavanagh, EG,Walsh, SR
International journal of surgery (London, England)
The role of venous diameter in predicting arteriovenous fistula maturation: When not to expect an AVF to mature according to pre-operative vein diameter measurements? A best evidence topic
WOS: 6 ()
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Arteriovenous fistula AVF Vein diameter Fistula maturation Primary AVF maturation Secondary maturation Cumulative maturation Fistula salvage procedures Preoperative venous mapping Preoperative venous duplex ACCESS
This best evidence topic was investigated according to a described protocol. We asked the question: what is the minimal vein diameter that can successfully predict maturation of an arteriovenous fistula ( AVF) in patients undergoing dialysis. Using the reported search 804 papers were found, of which five represented the best evidence to answer the clinical question. All studies assessed the association between successful AVF maturation and the size of vein used. The strongest evidence came from a nonrandomised controlled follow-up study in which 76% of fistulas created using > 2 mm cephalic vein successfully matured compared to 16% when the vein measured 4 mm compared to 45% with veins = 2.5 mm following tourniquet application resulted in more fistulas been created that would have otherwise been denied based on venous ultrasound mapping. A large multicentre randomised clinical trial assessing the use of different vein sizes both with and without tourniquet application using proper statistical tools - such as receiver operating characteristic - is required to make a final recommendation. Until then, a vein diameter of < 2.5 mm should be considered inadequate for formation of an AVF, particularly if those measurements remain unchanged following the use of tourniquet. (C) 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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