The arteriovenous access stage (AVAS) classification

Author:

Baláž Peter12,Hanko Jennifer3,Magowan Hannah3,Masengu Agnes3,Lawrie Katarina1,O’Neill Stephen3

Affiliation:

1. Department of Surgery, Faculty Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czechia

2. Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovak Republic

3. Department of Transplant Surgery, and Regional Nephrology Unit, Belfast City Hospital, Belfast, UK

Abstract

Abstract Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference22 articles.

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2. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS);Schmidli;Eur J Vasc Endovasc Surg,2018

3. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update;Lok;Am J Kidney Dis,2020

4. Proximal forearm fistula for maintenance hemodialysis;Gracz;Kidney Int,1977

5. End-stage vascular access failure: can we define and can we classify?;Al Shakarchi;Clin Kidney J,2015

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1. Management of an aneurysmal arteriovenous fistula in kidney transplant recipients;Transplantation Reviews;2023-12

2. Arteriovenous Fistula Aneurysm: Bench to Bedside;Indian Journal of Surgery;2022-04-25

3. VAVASC study: Clinical trial protocol;The Journal of Vascular Access;2021-09-02

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