Intraoperative transit time flow measurement predicts maturation of radiocephalic arteriovenous fistulas

Objective The arteriovenous fistula (AVF) is the first choice for gaining vascular access for hemodialysis. However, 20-50% of AVFs fail within 4 months after creation. Although demographic risk factors have been described, there is little evidence on the intraoperative predictors of AVF maturation failure. The aim of this study was to assess the predictive value of intraoperative transit time flow measurements (TTFM) on AVF maturation failure. Methods In this retrospective cohort study, the intraoperative blood flow, measured using TTFM, was compared to AVF maturation after 6 weeks in 55 patients. Due to its significantly higher prevalence and risk of non-maturation, the radiocephalic AVF (RCAVF) was the main focus of this study. A recommended cut-off point for high versus low intraoperative blood flow was determined for RCAVFs, using an ROC curve. Results The average intraoperative blood flow in RCAVFs was 156 mL/min. Patients with an intraoperative blood flow equal or lower than the determined cut-off point of 160 mL/min, showed a 3.03 times increased risk of AVF maturation failure after 6 weeks, compared to patients with a higher intraoperative blood flow (P < .001). Conclusion The intraoperative blood flow in RCAVFs measured by TTFM provides an adequate means of predicting AVF non-maturation 6 weeks after surgery. For RCAVFs, a cut-off point for intraoperative blood flow of 160 mL/min is recommended for maximum sensitivity and specificity to predict AVF maturation failure after 6 weeks.