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Title: Predicting outcomes of arteriovenous fistulas in patients with end stage renal disease
Author: McGrogan, Damian
ISNI:       0000 0004 6059 463X
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2016
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It remains challenging to accurately predict whether an individual arteriovenous fistula (AVF) will mature and be useable for haemodialysis vascular access. In part, this is due to the heterogeneity of end stage renal disease (ESRD) populations studied as these have varied in terms of age structure, background ethnicity and the relative prevalence of different renal disease aetiologies. The natural history of AVF maturation is also confounded by multiple co-morbid conditions, such as diabetes and peripheral vascular disease, which may be present in ESRD patients. This thesis outlines the current practices for preoperative clinical assessment of patients coming to AVF formation and explores the potential novel methods of predicting AVF patency outcomes. We characterise the age related mortality of patients undergoing AVF formation revealing a high post operative mortality for those over 75 years of age and present a meta-analysis of AVF outcomes in elderly patients demonstrating significantly poorer outcomes for distal versus proximal fistulas. We analyse the impact of surgical training on AVF outcomes concluding that results are not adversely affected by supervised surgical trainees. We also present the results of implementing the recommendations from international longitudinal studies to establish a ’Fistula Fast' pathway and examine the impact this has on AVF outcomes and its subsequent reduction in central venous catheter usage in our unit. Finally, this thesis presents preliminary work in diagnosing arterial stiffness and endothelial dysfunction using non-invasive methods of pulse wave velocity and near infra-red spectroscopy and, explore how these results can be used as a novel predictor of AVF outcomes in the ESRD population.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available