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Agreement Of Surgeon’s Choice Of Arteriovenous Fistula With A Vascular Access Selection App And Correlation With One-year Outcomes
Bright Bright, MD1, Kihoon Bohle, BSc
2, Eric K. Peden, MD
1;
1Division of Vascular Surgery, Houston Methodist Hospital, Houston, TX, USA,
2School of Engineering Medicine, Texas A&M University, Houston, TX, USA
OBJECTIVES:To evaluate the appropriateness of surgeons’ choice of arteriovenous fistula (AVF) as determined by a vascular access selection app, and investigate impact on 1-year outcomes.
METHODS:Autologous AVFs created in our institution between January and May 2021 were reviewed and ranked as appropriate, intermediate, or inappropriate using “My Vascular Access” app. Patients were then stratified into 2 groups (Group A = appropriate; Group B= inappropriate/intermediate) and their outcomes compared. The primary endpoint was access thrombosis.
RESULTS:Our cohort consisted of 89 subjects with a mean age of 64±15 years, of which 13% were in pre-dialysis. Preoperative vein mapping revealed a forearm cephalic vein diameter of 2.4±1.3 mm, basilic vein of 4.3±1.8 mm and radial artery measured 2.4±0.7mm. Radiocephalic fistulas were created in 41 cases (46%) (Fig 1). The app rated 65% of AVFs (n=58) as appropriate, 21% inappropriate and 9% intermediate, but 4 accesses - 3 brachiobasilic and 1 brachio-brachial - were not ranked. The median time from access creation to cannulation was 2 months (1-3) and did not significantly differ between groups. On the other hand, freedom from access thrombosis was greater in group A (95±3% vs 74±8%; p=0.007) (Fig2). There was also a numerical trend toward a higher primary patency rate in Group A (46±7% vs 25±8%, p=0.08), with no significant difference in one-year cumulative patency (80±5% vs 73±9%, p >0.05) or access usage rate (75% vs 69%; p>0.05). One-year mortality rates were 8% and 7% respectively (p>0.05).
CONCLUSIONS:Adopting “My Vascular Access” app to guide AVF selection could be associated with less risk of access thrombosis. However, this did not lead to a significant gain in one-year access usage rate or cumulative patency in our limited cohort. Larger studies are warranted to establish the association between adherence to this mobile app and outcomes.
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