Arteriovenous Fistula Maturation

One of the problems that continue to challenge patients starting hemodialysis (HD) and the physicians who provide their access is whether or not their arteriovenous fistulae (AVF) will mature successfully. To address this what it means for an AVF to “mature” must first be defined. Based on the latest KDOQI guidelines, “maturation” is defined as an AVF that can provide successful HD with two needles in at least two-thirds of HD sessions for four consecutive weeks. Once an AVF is created, close follow-up is required to monitor the maturation progress. Exercise programs and pneumatic compression devices can be prescribed as a non-invasive adjunct to assist maturation. During follow up, thorough physical examination and duplex sonography are performed to evaluate size, volume flow, and depth, as well as to identify any factors negatively affecting maturation such as the presence of stenoses or stealing branches, which if present should prompt timely intervention. Surgical and endovascular techniques such as revision and balloon assisted maturation have shown promising results in assisting maturation. AVF maturation is an issue that requires careful attention from the physician in order to provide the best outcome for patients undergoing HD.