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Home > Vascular Annual Meeting > pvss20_wahlgren_outcomes

PVSS20. Duplex-Derived Access Volume Flow (DAVQ): A Novel Predictor of Success Following Endovascular Repair of Failing or Non-Maturing Arterial-Venous Fistulas (AVF) for Hemodialysis

Anil Hingorani, Enrico Ascher, Natalie Marks, Alexander Shiferson, Alessandra Puggioni, Victor Tran, Nirav Patel, Theresa Jacob.
Maimonides Medical Center, Brooklyn, N.Y.

OBJECTIVES: To evaluate the feasibility of DAVQ to predict success or failure of AVFs after interventions.

METHODS: DAVQ measurements were available following 88 AVFs in 59 patients. Of these, 23 were found to be either non-maturing (12) or failing (11) by clinical exam and/or duplex scanning. Outflow stenoses (1 to 4, mean 1.2±0.8) were confirmed by contrast fistulograms in all cases (17 peripheral; 6 central). These 23 cases underwent successful endovascular repair (17 balloon angioplasty; 6 stents) and had pre and post-intervention DAVQ measurements within 2 weeks of the procedure. Each was measured 3x in a non-tortuous venous segment with laminar flow and mean values were used for comparison.

RESULTS: Overall mean DAVQ for 65 functioning AVFs was 1199±485 ml/min while it was 652±438 ml/min (150 to 1840ml/min) for the remaining failing or non-maturing 23 cases (p<0.0001). Post-intervention, the latter values changed to 867±517 ml/min (257 to 2020 ml/min) with a p<0.13. Of these, 11 were still non-functional after endovascular procedures and had a mean DAVQ of 404±111 ml/min (257 to 652 ml/min). The remaining 12 cases had a mean DAVQ of 1280±382 ml/min (762 to 2020 ml/min) and were functional and usable for at least 6 months follow-up (p<0.0001). It is of interest to note that none of the AVF cases with post-intervention DAVQ<700 ml/min became functional and usable while all cases with higher DAVQ underwent successful hemodialysis treatments.

CONCLUSIONS: This early experience suggests that DAVQ can be used to predict the success or failure of an AVF following endovascular procedures. To our knowledge this is the first such report.