Factors Associated with Early Thrombosis after Arteriovenous Fistula Creation

Background Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center. Methods Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery. Results There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged. Conclusions Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis. Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center. Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery. There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged. Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis.