Accessory Vein Obliteration Criteria for Immature Fistulae: A Modest Proposal for an Old Paradigm. Issue 5 (6th May 2014)

• Record Type: Journal Article
• Authors: Haq, Naveed Ul; Albaqumi, Mamdouh
• Is Part Of: Seminars in dialysis. Volume 27:Issue 5(2014)
• Page Start: E51
• Page End: E54
• Publication Date: 2014-05-06
• Subjects: Hemodialysis -- Periodicals; Dialysis -- Periodicals; Renal Dialysis -- Periodicals; 617.461059
• DOI: 10.1111/sdi.12239
• Languages: English
• ISSNs: 0894-0959

Abstract

<abstract abstract-type="main" id="sdi12239-abs-0001"> <title>Abstract</title> <p>Venous stenosis and/or presence of accessory vein (<italic>av</italic>) are the two most common causes of early fistula failure. While treatment of stenosis is better defined, there are no clear criteria for obliteration of the <italic>av</italic>. Often, interventionalists rely on visual assessment of flow through the <italic>av</italic> and its diameter (significant if &gt; 1/3 of the main fistula diameter) for intervention. The purpose of this study was to establish objective criteria for the management of <italic>av</italic>. Various computational fluid dynamics simulations were performed to analyze blood flow in the arteriovenous fistula (AVF). <italic>av</italic> of different diameters and angles was then added at various locations in the AVF and comparison of simulation results was undertaken. The computational model revealed that when the <italic>av</italic> was 33% of the diameter of the AVF, flow in <italic>av</italic> was only 7%. When diameter of the <italic>av</italic> was increased to 50% and 66% of the diameter of the AVF, flow through the <italic>av</italic> was 10% and 31% of the flow in main AVF, respectively. Location or angle of take‐off of <italic>av</italic> did not alter flow. This report provides objective information regarding criteria for <italic>av</italic> obliteration. It needs to be further validated in randomized clinical trials.</p> </abstract>