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Full length article| Volume 83, P108-116, July 01, 2022

Autogenous Vascular Access in American Indians

Published:December 22, 2021DOI:https://doi.org/10.1016/j.avsg.2021.11.026
Autogenous Vascular Access in American Indians
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Next ArticleAssessment of Duplex Ultrasound Carried Out by the Vascular Surgeon After Locoregional Anesthesia for Preferred Arteriovenous Fistula Access

      Highlights

      • •
        Type of Research: Single-center, retrospective cohort study.
      • •
        235 consecutive new American Indian patients had an autogenous vascular access created during a ten-year period. 85% were diabetic and 27% obese.
      • •
        Primary and cumulative patency rates were 46% and 94% at 24 months, respectively.
      • •
        Male gender and obesity were associated with lower patency.
      • •
        Conclusion: Safe and functional arteriovenous fistulas can be created for American Indians despite a high prevalence of diabetes.

      Background

      American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients.

      Methods

      Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4–6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm.

      Results

      235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15–89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04).

      Conclusions

      Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity.

      Keywords

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      REFERENCES

        • Malas MB
        • MD Canner JK
        • Hicks CW
        • et al.
        Trends in incident hemodialysis access and mortality.
        JAMA Surg. 2015; 150: 441-448
        View in Article

      2. Jennings W, Blebea J. The optimal initial choice for permanent arteriovenous hemodialysis access. position: excellent long-term outcomes for autogenous arteriovenous access justify an autogenous approach for most patients. J Vasc Surg;58:539-48.

        View in Article

      3. Leermakers, JJPM, Bode AS, Vaidya A, et al. Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulas versus arteriovenous grafts. European journal of vascular and endovascular surgery. 2012.

        View in Article
        • Woo K
        • Gascue L
        • et al.
        • Variations in outcomes of hemodialysis vascular access by
        Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly.
        J Vasc Surg. 2017; 65: 783-792
        View in Article
        • Yan Y
        • Ye D
        • Yang L
        • et al.
        A meta-analysis of the association between diabetic patients and AVF failure in dialysis.
        Ren Fail. 2018; 40 (PMID: 29724122; PMCID: PMC6014481): 379-383https://doi.org/10.1080/0886022X.2018.1456464
        View in Article
        • Kats M
        • Hawxby AM
        • Barker J
        • et al.
        Impact of obesity on arteriovenous fistula outcomes in dialysis patients.
        Kidney Int. 2007; 71: 39-43https://doi.org/10.1038/sj.ki.5001904
        View in Article

      7. United States Renal Data System. 2015 USRDS annual data report: epidemiology of kidney disease in the United States.Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015.

        View in Article
        • Norris T
        • Vines PL
        • Hoeffel EM.
        The American Indian and Alaska Native population.
        Administration US Department of Commerce Economics and Statistics Administration. ed. 2010. Census Briefs, Washington, DC: US Census Bureau2012: 1-21
        View in Article

      9. U.S. Census Bureau. (2012, January). C2010BR-10: 2010 Census Briefs: The American Indian and Alaska Native Population: 2010.

        View in Article

      10. https://www.ncai.org/about-tribes/demographics Accessed May 18, 2021.

        View in Article

      11. https://worldpopulationreview.com/state-rankings/native-american-population Accessed May 18, 2021.

        View in Article

      12. U.S. Census Bureau. (2012, January). C2010BR-10: 2010 Census Briefs: The American Indian and Alaska Native Population: 2010. https://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf accessed July 17, 2021.

        View in Article
        • Leichenko R.
        Housing and economic development in Indian Country: Challenge and opportunity.
        Routledge Publishing, New York: NY2018
        View in Article

      14. Demographic Turning Points for the United States: Population Projections for 2020 to 2060 Population Estimates and Projections Vespa J, Armstrong DM, Medin L. Current Population Reports March 2018. https://www.seniorlifestylemortgage.com/media/2018/5/ce7b2af1-5aa7-4c2e-8836-174fe5066868-1526987085564.pdf Accessed May 18, 20121.

        View in Article

      15. Indian Health Service. (2019, October). Disparities. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf Accessed July 12, 2021.

        View in Article

      16. https://www.ncai.org/about-tribes/demographics Accessed May 18, 2021.

        View in Article

      17. United States Renal Data System. USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, United States Renal. Data Syst 2015;2015.

        View in Article

      18. CDC Health Disparities and Inequalities Report e United States, 2013. Mor Mort Wkly Rep CDC Surveill Summ. 2013; 62(suppl 3):1-186.

        View in Article
        • Narva AS
        • Sequist TD.
        Reducing health disparities in American Indians with chronic kidney disease.
        Semin Nephrol. 2010; 30: 19-25
        View in Article
        • Maliska III CM
        • WC Jennings
        • A Mallios
        When arteriovenous fistulas are too deep: options in obese individuals.
        2015 JAmCollSurg. 2015; 221: 1067-1072
        View in Article
        • Jennings WC
        • Mallios A
        • Blebea J.
        Upper extremity permanent hemodialysis access placement.
        in: Darling RC Ozaki CK Master Techniques in Surgery: Vascular Surgery: Hybrid, Venous, Dialysis Access, Thoracic Outlet, and Lower Extremity Procedures. Ch.16. Wolters Kluwer, Philadelphia2015: 151-163
        View in Article
        • Jennings WC
        • Parker DE.
        Creating arteriovenous fistulas using surgeon-performed ultrasound.
        J Vasc Access. 2016; 17: 333-339
        View in Article
        • Jennings WC.
        • Mallios A
        • Mushtaq N.
        Proximal radial artery arterovenous fistula for hemodialysis access.
        J Vasc Surg. 2018; 6: 244-253
        View in Article

      24. https://www.cdc.gov/media/releases/2017/p0110-diabetes-native-americans.html Accessed May 18, 2021.

        View in Article

      25. https://www.kidney.org/atoz/content/AmericanIndians-KD Accessed May 18, 2021.

        View in Article
        • Bullock A
        • Burrows NR
        • Narva AS
        • et al.
        Vital signs: decrease in incidence of diabetes-related end-stage Renal disease among American Indians/Alaska natives - United States, 1996-2013.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 26-32
        View in Article

      27. https://www.cdc.gov/media/releases/2017/p0110-diabetes-native-americans.html Accessed May 18, 2021.

        View in Article
        • Locham S
        • Naazie I
        • Canner J
        • et al.
        Incidence and risk factors of sepsis in hemodialysis patients in the United States.
        J Vasc Surg. 2021; 73: 1016-1021
        View in Article
        • Sidawy AN
        • Spergel LM
        • Besarab A
        • et al.
        The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access.
        J Vasc Surg. 2008; 48: 2S
        View in Article

      30. https://esrdncc.org/en/fistula-first-catheter-last Accessed May 18, 2021.

        View in Article
        • Lok CE
        • Huber TS
        • Lee T
        • et al.
        KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update.
        Am J Kidney Dis. 2020; 75 (suppl 2): S1-S164
        View in Article
        • Arnaoutakis DJ
        • Deroo EP
        • McGlynn P
        • et al.
        Improved outcomes with proximal radial-cephalic arteriovenous fistulas compared with brachial-cephalic arteriovenous fistulas.
        J Vasc Surg. 2017; 66: 1497-1503
        View in Article

      33. Horst V, Nelson PR, Mallios A, et al. Avoiding hemodialysis access-induced distal ischemia. JVasc Access, invited review. July 25, 2020.

        View in Article
        • Kalantar-Zadeh Kamyar
        • Abbott Kevin C
        • Salahudeen Abdulla K
        • et al.
        Survival advantages of obesity in dialysis patients.
        Am J Clin Nutr. 2005; 81: 543-554
        View in Article
        • Cho P
        • Geiss LS
        • Burrows NR
        • et al.
        Diabetes-related mortality among American Indians and Alaska natives, 1990–2009.
        Am J Public Health. 2014; 104: S496_S503
        View in Article

      Article Info

      Publication History

      Published online: December 22, 2021
      Accepted: November 15, 2021
      Received in revised form: November 12, 2021
      Received: September 11, 2021

      Footnotes

      ☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Identification

      DOI: https://doi.org/10.1016/j.avsg.2021.11.026

      Copyright

      © 2021 Elsevier Inc. All rights reserved.

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