LAUSR

OBJECTIVE Current scientific evidence is insufficient to determine the best vascular access for each patient. It is a clinical unmet need since vascular access dysfunction accounts for 20-30% of hospital admissions. Our aim was to evaluate pre-operative ColorFlow Duplex Ultrasonography (CDUS) derived parameters (vein diameter and brachial artery flow and diameter) and their effect interaction with comorbidities as predictors of brachio-cephalic (BC) and brachio-basilic (BB) arteriovenous fistula (AVF) maturation. METHODS Prospective analysis of patients who underwent BC and BB AVF as primary definitive vascular access between January 2016 and May 2017. VARIABLES patients' demographics, comorbidities, medication, pre-operative blood pressure and CDUS-derived parameters. OUTCOMES patency 48 hours after surgery and fistula maturation at six and twelve weeks. Non-parametric descriptive and univariate statistics were used. Logistic regression models and ROC curve analyses were performed. RESULTS 132 patients (91 with BC and 41 with BB AVF were included). 48h patency was 91.7%, AVF maturation at 6 weeks was observed in 71.3% and AVF maturation at 12 weeks was observed in 66.3%. There were no associations in univariate and multivariate logistic regression analysis between AVF maturation and comorbidities. Systolic blood pressure (SBP) was an independent predictor of 48h patency with an optimized cut-off of 154mmHg (AUC=.73; p=.013; Youden index=.40). Vein diameter with tourniquet (VDt) was an independent predictor of AVF maturation at 6 and 12 weeks with an optimized cut-off of 3.9mm (AUC=0.74; p<.001; Youden index=0.38) CONCLUSIONS: AVF maturation was independent of comorbidities. SBP ≥ 154mmHg and VDt ≥ 3.9mm were the associated conditions that better predicted BC and BB maturation. There were no effect interactions between CDUS-derived parameters and associated comorbidities.