Salient Features of India constitution especially power and functions
EP2: Anastomotic Angle / FMD Impact On AVF Maturation
1. Sonusing Patil, Ilangovan V, Ramaswami, Vasanth G, Nirmala.V.R, Vikas C, Sidhram K, G. Bakthavathsalam
K.G Hospital and Post graduate Medical Institute , Coimbatore
Background
•Arteriovenous fistula (AVF) = “Achilles heel” for HD
•Maturation of an AVF
Complex process
Not well understood
•Factors that may affect AVF maturation
1.Surgical expertise 1
2.Vascular health factors (diameter of vessels) 2
3.Location and angle of anastomosis 3
4.Endothelial function 4
•Primary outcome:
Correlation between endothelial function by Angiodefender® method
- AVF maturation at 6 weeks
•Secondary outcome:
Role of anastomosis angle - AVF maturation
Other parameters like co-morbid conditions, smoking, age, RAAS
blockade and their impact on maturation
Parameters
AVF Success
n = 20
AVF Failure
n = 5
p Value
Age (years) 55.85±14.49 54.80±9.47 0.348
Gender (Male) 12/16 (75%) 4/16 (25%) 0.321
Angiodefender value 7.10±2.64 7.68±2.37 0.964
AVF surgeries 1.15±0.36 1.20±0.44 0.620
Smoker 9 0 0.001
Hemoglobulin (g/dl) 8.24±1.57 6.90±0.73 0.108
Diabetes Mellitus 12/17 (71%) 5/17(29%) 0.135
Hypertension 6/7 (85%) 1/7 (15%) 0.084
ACEi/ARB 7/7 (100%) 0/7 0.002
Anastomosis angle (º) 105.79±18.80 100.00±25.73 0.518
Angiodefender- AVF Maturation
Result
Anastomosis Angle- Distribution
•AVF angle below 95% i.e. acute angle, the chance of AVF failure was
50% (trend only, not significant)
•Endothelial function (Angiodefender value) does not predict AVF
maturation
•Larger sample size are being studied
To access the role of endothelial function as measured with FMD
using Angiodefender and anastomosis angle in AVF maturation
Background
Aim
Objectives
•Prospective observational study at K.G. Hospital, Coimbatore
•24 consecutive CKD-5 and CKD-5 HD patients undergoing AVF
irrespective of previous fistula failure status were included
•Vascular endothelial function
•Angiodefender: Ultrasound independent measure of flow-mediated
vasodilatation [FMD]. Vascular age and FMD value
•Surgeon was blinded to Angiodefender value
•Arteriovenous anastomosis picture
•Post vascular clamp release
•Using Photograph Image= Standardized procedure
Materials and Methods
AVF angle
1. MacRae et al. Role of vascular function in predicting arteriovenous fistula outcomes: an
observational pilot study. Canadian journal of kidney health and disease. 2015 May
4;2(1):1.Hemodial Int. 2015 Apr;19(2):296-305
2. Gibyeli Genek et al. Can primary failure of arteriovenous fistulas be anticipated?. Hemodial
Int. 2015 Apr 1;19(2):296-305.
3. Okoye KM et al. Effect of Anastomotic Angle on Pressure Drop in Arteriovenous Fistulae. In
ASME 2013 Summer Bioengineering Conference 2013 Jun 26. American Society of
Mechanical Engineers. J Vasc Access 2010; 11(4): 329 – 334
4. Owens CD et al. Endothelial function predicts positive arterial-venous fistula remodeling in
subjects with stage IV and V chronic kidney disease. J Vasc Access. 2010 Oct;11(4):329.
References
Conclusion
Anastomotic angle
AGE
Maturation
Fistula Success
Fistula Failed
Fistula not done
p = 0.964
Number
Angle
Fistula Maturation
Fistula Failure
p= 0.518
![Sonusing Patil, Ilangovan V, Ramaswami, Vasanth G, Nirmala.V.R, Vikas C, Sidhram K, G. Bakthavathsalam
K.G Hospital and Post graduate Medical Institute , Coimbatore
Background
•Arteriovenous fistula (AVF) = “Achilles heel” for HD
•Maturation of an AVF
Complex process
Not well understood
•Factors that may affect AVF maturation
1.Surgical expertise 1
2.Vascular health factors (diameter of vessels) 2
3.Location and angle of anastomosis 3
4.Endothelial function 4
•Primary outcome:
Correlation between endothelial function by Angiodefender® method
- AVF maturation at 6 weeks
•Secondary outcome:
Role of anastomosis angle - AVF maturation
Other parameters like co-morbid conditions, smoking, age, RAAS
blockade and their impact on maturation
Parameters
AVF Success
n = 20
AVF Failure
n = 5
p Value
Age (years) 55.85±14.49 54.80±9.47 0.348
Gender (Male) 12/16 (75%) 4/16 (25%) 0.321
Angiodefender value 7.10±2.64 7.68±2.37 0.964
AVF surgeries 1.15±0.36 1.20±0.44 0.620
Smoker 9 0 0.001
Hemoglobulin (g/dl) 8.24±1.57 6.90±0.73 0.108
Diabetes Mellitus 12/17 (71%) 5/17(29%) 0.135
Hypertension 6/7 (85%) 1/7 (15%) 0.084
ACEi/ARB 7/7 (100%) 0/7 0.002
Anastomosis angle (º) 105.79±18.80 100.00±25.73 0.518
Angiodefender- AVF Maturation
Result
Anastomosis Angle- Distribution
•AVF angle below 95% i.e. acute angle, the chance of AVF failure was
50% (trend only, not significant)
•Endothelial function (Angiodefender value) does not predict AVF
maturation
•Larger sample size are being studied
To access the role of endothelial function as measured with FMD
using Angiodefender and anastomosis angle in AVF maturation
Background
Aim
Objectives
•Prospective observational study at K.G. Hospital, Coimbatore
•24 consecutive CKD-5 and CKD-5 HD patients undergoing AVF
irrespective of previous fistula failure status were included
•Vascular endothelial function
•Angiodefender: Ultrasound independent measure of flow-mediated
vasodilatation [FMD]. Vascular age and FMD value
•Surgeon was blinded to Angiodefender value
•Arteriovenous anastomosis picture
•Post vascular clamp release
•Using Photograph Image= Standardized procedure
Materials and Methods
AVF angle
1. MacRae et al. Role of vascular function in predicting arteriovenous fistula outcomes: an
observational pilot study. Canadian journal of kidney health and disease. 2015 May
4;2(1):1.Hemodial Int. 2015 Apr;19(2):296-305
2. Gibyeli Genek et al. Can primary failure of arteriovenous fistulas be anticipated?. Hemodial
Int. 2015 Apr 1;19(2):296-305.
3. Okoye KM et al. Effect of Anastomotic Angle on Pressure Drop in Arteriovenous Fistulae. In
ASME 2013 Summer Bioengineering Conference 2013 Jun 26. American Society of
Mechanical Engineers. J Vasc Access 2010; 11(4): 329 – 334
4. Owens CD et al. Endothelial function predicts positive arterial-venous fistula remodeling in
subjects with stage IV and V chronic kidney disease. J Vasc Access. 2010 Oct;11(4):329.
References
Conclusion
Anastomotic angle
AGE
Maturation
Fistula Success
Fistula Failed
Fistula not done
p = 0.964
Number
Angle
Fistula Maturation
Fistula Failure
p= 0.518](https://image.slidesharecdn.com/ep2anastomoticanglefmdimpactonavfmaturation-160721140936/85/EP2-Anastomotic-Angle-FMD-Impact-On-AVF-Maturation-1-320.jpg)
