Usefulness of assisted procedures for arteriovenous fistula maturation without compromising access patency.

Introduction: To increase the rate of arteriovenous fistula (AVF) use, assisted procedures for immature AVF have been strenuously performed. However, this is controversial in that an AVF matured by these assisted procedures may require more frequent intervention to maintain its patency, and have decreased long-term patency. Methods: Eighty four AVFs that were matured with assisted maturation procedures and 266 AVFs that matured spontaneously without intervention, created between November 2009 and March 2013 from the hemodialysis (HD) vascular access (VA) cohort, were compared retrospectively and we also investigated the factors that may influence AVF long-term patency. Median follow-up was 26.8 months (interquartile range, 6.6-45.0 months). Findings: Access survival did not differ between AVFs matured by assisted procedures and spontaneously mature AVFs (P=0.29). In multivariate Cox regression analysis of AVF survival, age (HR, 1.029; 95% CI, 1.004-1.056; P=0.024), maturation without assisted procedures 4-6 weeks after AVF creation (HR, 0.233; 95% CI, 0.107-0.506; P<0.001), and AVF thrombosis (HR, 26.511; 95% CI, 10.986-63.978; P<0.001) were significantly associated with AVF survival. Performance of assisted procedures to induce AVF maturation did not influence AVF survival (HR, 0.437; 95% CI, 0.191-1.002; P=0.05). Discussion: Our results support that idea that assisted maturation procedures can ensure the success of immature AVF without compromising long-term patency. These procedures can be considered more positively for increasing AVF use for VA placement in HD patients.