Maximizing Native Arteriovenous Fistulae Rates.

NCT ID: NCT02705417

Last Updated: 2016-03-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

136 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-01-31

Study Completion Date

2015-01-31

Brief Summary

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The purpose of our study is to compare physical examination alone to color Doppler ultrasonography (CDUS) vascular mapping and physical examination in terms of outcomes of vascular access and long-term patency.

Detailed Description

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Fistula maturation is a complex vascular remodelling process that requires vessel dilation, increases in volume flow rates in the feeding artery and afferent vein and structural alterations of the vascular wall. The understanding of these procedures and the factors involved in promoting maturation is limited. In this context, one of the major areas requiring investigation is the identification of clinically useful pre-operative predictors of access outcome.

Traditionally, the selection of vascular access and the eligibility for native arteriovenous fistula construction was mainly determined by findings of clinical examination. However, in addition to a complete history and physical examination, National Kidney Foundation/Dialysis Outcome Quality Initiative (NFK/DOQI) recommended that routine pre-operative color Doppler ultrasonographic vascular mapping should be performed in all hemodialysis patients who are candidates for access formation. This concerns the routine implementation of a non-invasive, safe and cost-effective method that permits the identification of vessels that are suitable for arteriovenous fistula (AVF) construction, acknowledging that supporting Level I evidence is still lacking. Indeed, available data supporting the significance of mapping on access maturation and patency rates are limited and conflicting.

The aim of the present study is to compare the type of preoperative assessment, physical examination alone to combined CDUS vascular mapping and physical examination, to outcomes of performed vascular access procedures with respect to type selection and long-term patency at 12 months in hemodialysis patients.

Conditions

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Kidney Failure Arteriovenous Shunt Hemodialysis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Group A

Patients in whom selection of vascular access relied upon physical examination and medical history, during pre-operative surgical assessment

physical examination

Intervention Type PROCEDURE

Arterial pulse examination, differential blood pressure measurements and the Allen test in both extremities. Inspection of the superficial venous system with tourniquet enhancement in the arm was performed during venous assessment.

medical history

Intervention Type PROCEDURE

medical history with respects to diabetes mellitus, coronary heart disease, peripheral vascular disease

native arteriovenous fistula construction

Intervention Type PROCEDURE

surgigal creation of native arterial and venous anastomoses

arteriovenous graft placement

Intervention Type PROCEDURE

surgical placement of arteriovenous graft

Group B

Patients who underwent vascular mapping using color Doppler Ultrasonography in addition to physical examination and history during pre-operative evaluation.

preoperative color Doppler ultrasonographic vascular mapping

Intervention Type PROCEDURE

Preoperative color Doppler ultrasonographic vascular mapping was performed with linear probe. The patient extremity under scrutiny was placed under support, with tourniquet augmentation. Vessels were examined in both short (transverse) and long (longitudinal) axis. Anatomical variations, wall morphology and internal diameters at the antecubital fossa, the proximal (cranial), mid and distal (caudal) third of the arm and forearm were assessed in both extremities. Veins were evaluated for compressibility and adequate drainage to deep venous system. The presence of sclerotic, thrombosed and fibrosed segments were noted. Doppler waveforms were obtained in the long axis and volume flow (VF) calculated for arteries selected for potential access construction.

physical examination

Intervention Type PROCEDURE

Arterial pulse examination, differential blood pressure measurements and the Allen test in both extremities. Inspection of the superficial venous system with tourniquet enhancement in the arm was performed during venous assessment.

medical history

Intervention Type PROCEDURE

medical history with respects to diabetes mellitus, coronary heart disease, peripheral vascular disease

native arteriovenous fistula construction

Intervention Type PROCEDURE

surgigal creation of native arterial and venous anastomoses

arteriovenous graft placement

Intervention Type PROCEDURE

surgical placement of arteriovenous graft

Interventions

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preoperative color Doppler ultrasonographic vascular mapping

Preoperative color Doppler ultrasonographic vascular mapping was performed with linear probe. The patient extremity under scrutiny was placed under support, with tourniquet augmentation. Vessels were examined in both short (transverse) and long (longitudinal) axis. Anatomical variations, wall morphology and internal diameters at the antecubital fossa, the proximal (cranial), mid and distal (caudal) third of the arm and forearm were assessed in both extremities. Veins were evaluated for compressibility and adequate drainage to deep venous system. The presence of sclerotic, thrombosed and fibrosed segments were noted. Doppler waveforms were obtained in the long axis and volume flow (VF) calculated for arteries selected for potential access construction.

Intervention Type PROCEDURE

physical examination

Arterial pulse examination, differential blood pressure measurements and the Allen test in both extremities. Inspection of the superficial venous system with tourniquet enhancement in the arm was performed during venous assessment.

Intervention Type PROCEDURE

medical history

medical history with respects to diabetes mellitus, coronary heart disease, peripheral vascular disease

Intervention Type PROCEDURE

native arteriovenous fistula construction

surgigal creation of native arterial and venous anastomoses

Intervention Type PROCEDURE

arteriovenous graft placement

surgical placement of arteriovenous graft

Intervention Type PROCEDURE

Other Intervention Names

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vascular mapping pre-operative mapping clinical examination Polytetrafluoroethylene (PTFE) synthetic graft

Eligibility Criteria

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Inclusion Criteria

* end stage renal disease

Exclusion Criteria

* poor life expectancy
* congestive heart failure New York Heart Association stage 3 and over
* candidates for tunneled catheters
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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International Renal Research Institute Vicenza

OTHER

Sponsor Role collaborator

Medifil AE

OTHER

Sponsor Role lead

Responsible Party

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Ioannis Emmanouel Giannikouris

Assistant for the Medical Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ioannis E. Giannikouris, PhD

Role: PRINCIPAL_INVESTIGATOR

Medifil AE Private Hemodialysis Centre

Other Identifiers

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1

Identifier Type: -

Identifier Source: org_study_id

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