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Metabolic Syndrome: A marker for decreased cumulative patency among patients undergoing arteriovenous fistula placement.
Clinton D. Protack, MD, Larissa Chiulli, MD, Penny Vasillas, RN, Caroline Jadlowiec, MD, Michael Collins, MD, Xin Li, MD, Alan Dardik, MD, PhD.
Yale University, New Haven, CT, USA.

OBJECTIVES:
The natural history of patients with Metabolic Syndrome (MetS) undergoing arteriovenous fistula placement is unknown. MetS has previously been found as a risk factor for poor outcomes for vascular surgery patients undergoing other interventions. The aim of this is study is to describe the outcomes of MetS patients undergoing primary arteriovenous fistula placement.
METHODS:
The medical records of all patients undergoing arteriovenous fistula placement between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=122). Survival, primary patency, and secondary patency were evaluated using Gehan-Breslow test for survival. MetS was defined as the presence of three or more of the following: blood pressure ≥130 mmHg/≥90 mmHg; triglycerides ≥150 mg/dl; high-density lipoproteins (HDL) ≤50 mg/dl for women and ≤40 mg/dl for men; Body Mass Index (BMI) ≥30 kg/m2; fasting blood glucose ≥110 mg/dl.
RESULTS:
One hundred and twenty-two patients underwent primary arteriovenous fistula placement. Seventy-five (61%) of the patients were identified to have MetS. The distribution of MetS factors among all patients were: 120 (98%) were hypertensive.; 70 (57%) patients were diabetic; 51(42%) patients had elevated triglycerides; 75(61%) of patients had decreased HDL; 46 (38%) of patients had an elevated BMI. 55 (45%) of patients were currently receiving hemodialysis. The mean age of patients was 65 years. The mean length of follow-up was 2.9 years. The forearm was site of fistula placement in 76 (62%) of patients; no difference existed between groups (39% for MetS, 36% for No MetS, p = 0.78). The median time to primary failure was 0.57 years for all patients (0.76 years[No MetS], 0.47 years [MetS]; p = 0.11). Secondary patency was 50% at 1.28 years for all patients (1.72 years [No MetS], 0.72 years [MetS]; p = 0.01). Median survival duration for all patients was 4.7 years (5.2 years [No MetS], 4.5 years [MetS]; p = 0.03).
CONCLUSIONS:
MetS is prevalent among patients undergoing arteriovenous fistula placement. Patients with MetS have equivalent primary patency rates, however their survival and cumulative patency rates are significantly lower compared to those patients without MetS. MetS should be considered as a significant risk factor for patients undergoing arteriovenous fistula placement.


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