#2901 Analysis of primary survival and quality indicators of native arteriovenous fistulas performed during the period 2020–2023

Abstract Background and Aims The process from vascular access (VA) selection to creation and maintenance is still a challenge today. Based on studies and clinical guidelines, we can assess the quality of care of our patient's vascular access, thereby facilitating decision-making in daily clinical practice and ensuring better treatment and thereby increasing quality of life. We reviewed our results over three years in accordance with the quality criteria of a clinical guideline on vascular access for hemodialysis [1]. Method Retrospective study of native arteriovenous fistulas (nAVF) performed in our center during the period 2020–2023. The general characteristics of the patients and type of nAVF performed were collected, we calculated the primary survival of the vascular access for 40 months, analyzed by Kaplan-Meier and Log-rank methods. Subsequently, we proceeded to analyze the fulfillment of two quality indicators: Early failure of vascular access in the first 30 days from its creation (Outcome indicator; Standard: radiocephalic nAVF <35% and proximal nAVF <25% annually) and Immature arteriovenous fistula after 4 weeks from its creation (Process indicator, Approximate standard 28%–53% according to the literature). Results 233 AVFs were performed (165 men and 68 women). Regarding the age at the time of the fistula, 3.4% of the patients were in the age range between 25 and 40 years, 12.9% between 41 and 56 years, 36.1% between 57 and 72 years and 47.6% between 73 and 88 years. Of the total AVFs, 52.4% were radiocephalic, 29.2% humerocephalic, 2.6% humerobasilic, 8.6% humeromedian, 1.7% ulnar-cephalic, 5.6% humeroaxillary. Since the event was reintervention and considering the time until the date of data collection 11/12/2024 at 11.8 months, the probability of primary survival is 75% with no statistically significant differences between the type of nAVF and age groups. The result indicator determined an early nAVF failure of 38.9%. The process indicator determined that 40.3% of all the studied AVFs did not meet maturation criteria. 72% of the nAVFs performed were reviewed during the first 3–4 weeks, the rest were reviewed at 8–12 weeks. 51% of the radiocephalic nAVFs required reintervention, followed by humerocephalic nAVF with 36.5%, humerobasilic 9.5% and the rest <2%. Survival analysis Fig. 1. Conclusion We obtained an early failure rate higher than the recommended standard. As for the percentage of maturation, we were within the desired standard. Both indicators imply a worse survival of the vascular access. We believe that earlier follow-up during the first month after the procedure could imply an improvement for our results.