JVA

J Vasc Access 2016; 17 (6): 477-482

DOI: 10.5301/jva.5000599

ISSN 1129-7298 Original RESEARCH Article

Arterial stiffness and arteriovenous fistula failure

of maturation
Agnes Masengu1,2, Jennifer B. Hanko1, Alexander P. Maxwell1,2
1
Regional Nephrology Unit, Belfast City Hospital, Belfast - UK
2
Nephrology Research Group, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast - UK

Abstract
Purpose: Increased arterial stiffness is a common finding in patients with end-stage renal disease. Following
creation of an arteriovenous fistula (AVF), appropriate dilation of the feeding artery must occur to facilitate AVF
maturation. Arterial stiffness may impair the arterial dilation required to facilitate AVF development and contrib-
ute to subsequent failure to mature (FTM). The aim of this pilot study was to investigate the association between
measurements of central and peripheral arterial stiffness, and AVF FTM.
Methods: Patients undergoing AVF creation in a single centre (Belfast City Hospital, UK) between January and
December 2015 were invited to have their carotid-femoral pulse wave velocity (PWV), brachial-radial PWV and
augmentation index (AI) measured prior to AVF creation. Subsequent AVF outcomes were identified.
Results: Fifty-nine patients who had an AVF procedure were included in the final analysis (mean age 62 years);
50.8% had diabetes mellitus. The mean pre-operative arterial diameter for all AVFs was 3.9 mm. Average val-
ues for carotid-femoral PWV were 9.5 m/s, brachial-radial PWV 7.7 m/s and AI 25.6%. Using logistic regression,
these arterial stiffness parameters did not predict AVF FTM: carotid-femoral PWV (P = 0.20), brachial-radial PWV
(P = 0.13), AI (P = 0.50).
Conclusions: This is the largest study to date exploring the association between arterial stiffness and AVF FTM.
The measured central and peripheral arterial stiffness parameters were not associated with AVF FTM. Further
research is needed to define if non-invasive arterial physiological measurements would be clinically useful in the
prediction of AVF FTM.
Keywords: Arterial stiffness, Arteriovenous fistula, Augmentation index, Pulse wave velocity

Introduction Accelerated vascular aging and increased arterial stiffness

The creation of an arteriovenous fistula (AVF) involves
an anastomosis between a thick walled, elastic, highly pres-
surised arterial system and a compliant, distensible low pres-
sure venous system. Following anastomosis, arterial blood
flow must increase by at least 10- to 20-fold (1) for successful
fistula maturation. To facilitate this augmented and hyper-
dynamic blood flow, the arterial wall must dilate. Low arterial
wall elasticity with poor blood vessel dilatation has been sug-
gested to promote turbulence which stimulates the develop-
ment of a fistula stenosis resulting in failure of appropriate
AVF development and maturation (1).
Accepted: June 22, 2016
Published online: September 3, 2016
Corresponding author:
Agnes Masengu
Regional Nephrology Unit
Belfast City Hospital
51 Lisburn Road
Belfast BT9 7AB, UK
amasengu@doctors.org.uk
characterised by arterial medial calcification is a common
phenomenon in patients with chronic kidney disease (CKD)
and end-stage renal disease (ESRD) (2). Increased arterial
stiffness is linked to increased cardiovascular morbidity and
mortality (3) and has been suggested to be a more sensitive
marker of cardiovascular disease than carotid intima media
thickness and pulse pressure (4). Carotid-femoral pulse wave
velocity (PWV) analysis is considered by the European Society
of Hypertension and European Society of Cardiology (5) to be
the gold standard method of measuring arterial stiffness.
Cardiac contraction generates a pulse wave which is dis-
tributed to the extremities. The pressure wave is propagated
forward during systole until it reaches a barrier in the arterial
tree such as a branch division or change in vessel calibre, at
which point the pressure wave is reflected back. PWV is cal-
culated as the distance travelled by the pulse wave divided by
the time taken to travel that distance. Increased arterial stiff-
ness results in increased speed of the pulse wave in the ar-
tery. PWV can be measured in any arterial segment between
two regions.
Aortic stiffness influences arterial pressure wave ampli-
tude. Pulse wave analysis (PWA) can assess central aortic
pressures by analysis of the brachial pulse pressure wave,

© 2016 Wichtig Publishing

478
oscillatory pressure determination, and application of a
global transfer factor. The augmentation pressure (AP) is the
additional aortic systolic pressure generated by the applica-
tion of the reflected pulse wave to the forward wave. The
augmentation index (AI) is an indirect measure of arterial
stiffness calculated by dividing the AP by the pulse pressure
and then multiplying the result by 100 to obtain a percent-
age value.
While peripheral and central pulse pressure, AP, AI, aortic
and brachial PWV all increase noticeably with age, the age-
related changes in AI and aortic PWV have been shown to be
non-linear (6). As a consequence, AI may be a more sensitive
marker of arterial stiffening in patients less than 50 years of
age, while aortic PWV may be more accurate in patients older
than 50 years of age (6).
The aim of this pilot study was to investigate whether
arterial stiffness as measured by carotid-femoral PWV, bra-
chial-radial PWV, and aortic AI is associated with AVF failure
to mature (FTM).
Methods
Following research ethics committee approval (REC 14/
WA/1250) an observational cohort study was designed that
incorporated all patients aged ≥18 years with advanced re-
nal impairment (defined as an estimated glomerular filtration
rate less than 20 mL/min/1.73m2) attending a single centre
(Belfast City Hospital, Belfast, UK) who were having a first
native AVF procedure between January 2015 and December
2015.
Study assessment
The Vicorder™ system (Skidmore Medical, Bristol, UK)
was used to measure arterial vessel characteristics in the
form of pulse wave analysis (PWA) and pulse wave velocity
(PWV). The Vicorder™ is a small, portable, non-invasive and
non-operator-dependent device that has been validated in
several studies incorporating children and adults, including in-
dividuals with CKD with excellent tolerability (7-9). Individuals
participating in the study were rested in the supine position
for 10 to 15 minutes prior to the assessment. The Vicorder™
measurement was carried out in the same room at 24oC and
performed by a single operator. The brachial PWA and bra-
chial-radial PWV were measured in the arm with the blood
vessels previously identified by the surgeon for AVF creation.
A small 8 cm cuff was placed at the wrist and a 10 cm wide
blood pressure cuff placed mid-way along the upper arm. An
oscillatory blood pressure measurement was carried out fol-
lowed immediately by two subsequent measures of brachial
PWA. To calculate the brachial-radial PWV, the distance be-
tween the middle of both the proximal and distal cuffs was
measured in centimetres. Both arm cuffs were then inflated
by the Vicorder™ to 40-65 mmHg and the brachial-radial PWV
recorded over 10 heart beats before the cuffs were deflated.
Two sets of readings were taken and the average brachial-
radial PWV calculated.
To measure the carotid-femoral PWV, a plethysmographic
sensor embedded in a 3 cm cuff was placed over the carotid
region on the same side that the AVF would be created, to
Arterial stiffness and fistula failure of maturation
detect the carotid pulse wave. A 10 cm cuff was placed
around the upper thigh (on the same side of the body as the
associated carotid artery) as high on the thigh as possible.
The distance between the supra-sternal notch and the middle
of the thigh cuff was measured as an estimate of the distance
between the carotid and femoral arteries as per manufac-
turer instructions. The thigh cuff was subsequently inflated
by the Vicorder™ device to 65 mmHg and the carotid-femoral
PWV calculated over 5-10 heart beats. Two sets of read-
ings were taken to provide an average carotid-femoral PWV
value.
Data collection
In addition to the PWV and PWA results, patient clini-
cal and demographic data in the form of age, race, primary
renal disease, type of vascular access, medications, clinical
biochemistry, pre-operative blood vessel ultrasound mea-
surements (where available), co-morbidities and AVF out-
come were obtained from patient electronic care records
and the regional nephrology electronic database system
eMED (Mediqal Health Informatics Limited, Stevenage,
UK).
In Belfast City Hospital, routine pre-operative ultra-
sound assessment of blood vessels has been available at
a nephrologist-led vascular access clinic since September
2011. Patients are referred to the clinic at the discretion of
the nephrologist or surgeon. The duplex ultrasound exami-
nations were performed by a single practitioner (JBH) using
a Sonosite M-turbo ultrasound machine (Sonosite, Bothell,
WA, USA) with a high-frequency (13-6 MHz) linear probe.
Patients sat upright with the arm extended below heart
level. Vein diameter was recorded at 5 cm consecutive in-
tervals from the wrist crease and the ante-cubital fossa at
5, 10 and 15 cm. These three points were used to establish
a minimum vein diameter (MVD).
The radial or brachial arterial diameters were measured at
the wrist and ante-cubital fossa, respectively, during systole
(ulnar based AVFs are not routinely created in our unit). Peak
arterial velocity and arterial volume flow (VF) were measured
in both the radial and brachial arteries using colour Doppler
ultrasound in the longitudinal plane, approximately 5 cm
from the wrist crease and ante-cubital fossa, respectively, to
allow a straight segment of blood vessel for analysis. Peak ar-
terial velocity (cm/s) and arterial volume flow (VF) (mL/min-
ute) were measured using colour Doppler in the longitudinal
plane. The radial artery measurements were recorded for
radio-cephalic AVFs, and the brachial artery measurements
for brachio-cephalic AVFs.
The type of AVF created in our unit varies based on patient
age, co-morbidities, pre-operative clinical and ultrasound
findings plus surgeon practice patterns. During the study time
frame, five surgeons created AVFs. One surgeon preferred a
“distal AVF first” approach, two surgeons performed ultra-
sound measurements themselves (measurements not for-
mally recorded in paper charts or electronic patient records)
and determined the best site based on their findings, while
the remaining two surgeons created AVFs on the basis of
their clinical assessment and the ultrasound results from the
nephrology-led vascular access clinic.
© 2016 Wichtig Publishing
Masengu et al 479

Outcomes Table I - D
 emographics and clinical characteristics of patients in
the arterial stiffness study analysis
An AVF outcome end-date of the 4th February 2016 was
set. Outcomes were defined as follows: Characteristic Result
Clinical patency: suitable for haemodialysis use based on Mean age, years (SD, range) 62.2 (15.6, 23-83)
clinical examination and ultrasound assessment (AVF diam-
eter >0.6 cm, volume flow >600 mL/min, depth <0.6 cm) Male gender 67.8%
Failure to mature: defined as AVF thrombosis, failure to Mean systolic blood pressure (mmHg) 158
fulfil the ultrasound criteria for maturation as outlined above,
or failure to sustain 2-needle HD. Mean diastolic blood pressure (mmHg) 76
Average of mean arterial pressure 108
Statistical analysis readings (mmHg)
Co-morbidities
Statistical analysis was performed using SPSS version
  Diabetes 50.8%
22 (IBM Corp, Armonk, NY, USA). The independent samples
t-test was used to compare the means of continuous vari-   Peripheral vascular disease 6.8%
ables while the χ² test was used to compare proportions.   Coronary artery disease 27.1%
Spearman’s rank correlation coefficient was used to measure Pre-dialysis at AVF creation 74.6%
the degree of association between age, AI and PVW measure-
Previous AVF 22.0%
ments. Multi-variable logistic regression was used to examine
the relationship between variables and carotid–femoral PWV, Forearm arteriovenous fistula 39%
and binary logistic regression to explore the relationship be- SD = standard deviation; AVF = arteriovenous fistula.
tween arterial stiffness variables and AVF FTM.

Results Table II - Summary of ultrasound and arterial stiffness values

Sixty-six patients were recruited into the study and had Characteristic Number Mean SD SEM
measurements for PVW and PWA recorded. Four patients Arterial diameter (mm) 46 3.9 1.22 0.18
had their AVF procedures cancelled on the day immediately
prior to theatre attendance. Of the 62 patients that had an Arterial volume flow (mL/min) 46 158.1 125.43 18.49
AVF created, one AVF failed immediately, one was converted Arterial velocity (m/s) 41 76.9 21.64 3.38
to a loop arteriovenous graft and one patient had an unde- Minimum vein diameter (mm) 31 3.2 0.87 0.16
termined outcome by the study end date (awaiting further
review). These three patients were not included in the final Augmentation index (%) 59 25.7 7.02 0.92
analysis of 59 patients. Brachial-radial PWV (m/s) 59 7.7 1.44 0.19
The demographics and clinical characteristics of these pa-
Carotid-femoral PWV (m/s) 58 9.5 2.07 0.27
tients are shown in Table I. The average age of the patients
was 62 years with an age range of 23-83 years. All patients PWV = pulse wave velocity; SEM = standard error of the mean; SD = standard
were Caucasian and approximately two-thirds were male deviation.
(67.8%). Over half the patients in this cohort had diabetes
mellitus (50.8%) and the majority of patients had an upper
arm AVF created (61%). to mature. Of the 43 AVFs that achieved clinical patency,
A summary of the mean pre-operative ultrasound 22 sustained two-needle dialysis for more than six sessions
(where available) and arterial stiffness measurements is (two required further intervention prior to achieving this tar-
shown in Table II. The mean pre-operative arterial diam- get) and 21 patients were still pre-dialysis at the end of the
eter was 3.9 mm (SD 1.22) (mean radial artery diameter pilot study. The characteristics of the clinically patent AVFs
2.5 mm [SD 0.51] for radio-cephalic AVFs and mean brachial versus the AVFs that failed to mature (FTM) are detailed in
artery diameter 4.6 mm [SD 0.82] for brachial-artery based Table III. Lower arm AVFs were significantly more likely to fail
AVFs) and the minimum pre-operative venous diameter than upper arm AVFs (P = 0.02). There was a trend towards
3.2 mm (SD 0.87) (lower arm vein 2.8 mm [SD 0.59], up- lower mean arterial flow (P = 0.06) and reduced arterial ve-
per arm vein mm 3.4mm [SD 0.90]). With regard to arterial locities (P = 0.07) in the AVFs that failed to mature.
stiffness parameters, mean values were as follows: carotid- All three studied measures of arterial stiffness: carotid-
femoral PWV 9.5 m/s (SD 2.07), brachial-radial PWV 7.7 m/s femoral PWV (P = 0.20), brachial-radial PWV (P = 0.14) and
(SD 1.44) and AI 25.7% (SD 7.02). Increases in carotid-fem- AI (P = 0.52), were not significantly different between patent
oral PWV were associated with increases in brachial-radial AVFs and those AVFs that failed to mature (Fig. 1).
PWV (r = 0.42, P = 0.001) while AI negatively correlated Binary logistic regression using the three parameters of
with brachial-radial PWV (r = -0.34 and P = 0.009) in all arterial stiffness was subsequently used to investigate predic-
patients including individuals with diabetes. tors of the study outcome, i.e., AVF FTM: carotid-­femoral PWV
By the end date of 4th February 2016, 73% of AVFs (43/59) (P = 0.20), brachial-radial PWV (P = 0.13), and AI (P = 0.50)
achieved clinical patency while 27% (16/59) of the AVFs failed were not predictive of FTM in this cohort.

© 2016 Wichtig Publishing

480
Table III - Comparison of characteristics between the patent AVF group (n = 43) and the AVF group that failed to mature (n = 16)
Characteristic AVF FTM
Age years, mean (range) 57 (30-80)
Female gender 43.8%
Lower arm AVF 62.5%
Augmentation index (%) 26.0
Brachial-radial PWV (m/s) 8.0
Carotid-femoral PWV (m/s) 9.1
Diabetes mellitus 50.0%
Peripheral vascular disease 6.3%
Mean artery diameter (mm) 3.1
Mean artery velocity (m/s) 66.6
Mean artery volume flow (mL/minute) 96.8
Minimum vein diameter (mm) 3.0
PWV = pulse wave velocity; AVF = arteriovenous fistula.
Considering the 16 AVFs that did not mature, ten were
radio-cephalic AVFs and six were brachiocephalic AVFs. Three
thrombosed more than 14 days after creation, four had areas
of outflow stenosis, two had sclerosed veins, two had very
small veins on post-operative ultrasound follow-up and in five
cases no obvious cause was identified. Of note, 69% (10/16)
of the AVFs that failed to mature did not undergo formal pre-
operative ultrasound assessment of blood vessels at the vas-
cular access clinic.
Discussion
In this pilot study of arterial stiffness measurements
and AVF FTM in a Northern Irish cohort of patients, carotid-
femoral PWV, brachial-radial PWV and AI were not asso-
ciated with AVF FTM. Carotid-femoral PWV has not been
associated with AVF FTM in two previous smaller studies
(n = 26; n = 28) (1, 10). In theory, vascular disease in the
aorta should affect the dynamics of the arteries of the arm
just as it impacts on peripheral vessels in the brain, heart
and kidneys (2, 3).
At a histological level, abnormal calcification noted in
the radial and brachial arteries of individuals with CKD and
ESRD has been correlated with arterial stiffness as mea-
sured by PWV (11). The value of indirect brachial artery
measurements as a surrogate marker of arterial stiffness
remains under investigation (12, 13). The rate of increase
in aortic PWV that occurs as a result of aging and co-mor-
bidities has been suggested to exceed the rate of change
observed in the muscular arteries such as the brachial ar-
teries (14). In this study, increases in carotid-femoral PWV
correlated positively with increases in brachio-radial PWV.
It could be argued that central PWV measurements may
not reflect characteristics of the brachial artery which is
Arterial stiffness and fistula failure of maturation
Clinically patent AVF P value
64 (23-83) 0.14
27.9% 0.27
28.9% 0.02
25.6 0.85
7.6 0.30
9.7 0.40
48.8% 0.94
7.0% 0.92
4.1 0.02
80.6 0.07
177.4 0.06
3.2 0.60
actually used for AVF creation and hence central PWV may
be irrelevant to AVF outcomes.
It is possible that the significant number of upper arm
AVFs (61%) created in this study may have contributed to the
negative findings. A previous investigation of 26 patients us-
ing applanation tonometry to investigate the effect of arterial
elasticity on AVF FTM found that radial artery elasticity was
associated with a higher proportion of AVF maturation but
the same relationship was not evident for AVFs created using
the brachial artery (1). Previous work has also suggested that
radial artery calcification is associated with increased radio-
cephalic AVF FTM (15); the larger brachial artery is less likely
to be as severely calcified.
Further work focusing on the role of radial artery elastic-
ity prior to radio-cephalic AVF creation may be more clinically
relevant for these reasons than brachial artery elasticity mea-
surements.
It is possible that vascular changes associated with AVF
FTM may be independent of arterial elasticity at a certain
arterial diameter. In our study the mean arterial diameter
of 3.9 mm far exceeded the minimum arterial diameter of
2.0 mm recommended for AVF creation (16).
Co-morbidity may be a confounding factor in the relation-
ship between AVF FTM and arterial stiffness parameters. Indi-
viduals with diabetes mellitus formed over half of this cohort.
Diabetes is known to impair arterial vasomotor function due
to a combination of reduced nitric oxide availability as well as
nitric oxide-dependent pathways (17). In this study, there was
no correlation between age and the central stiffness mea-
surements in diabetic individuals (a feature usually seen in
the normal population and also observed in the non-diabetic
persons in this study).
A recent smaller study of 28 patients who had arterial
function measured using carotid-femoral PWV and peripheral
© 2016 Wichtig Publishing
Masengu et al
Fig. 1 - Boxplots comparing arteriovenous fistula (AVF) patency
outcome and augmentation index, brachio-radial pulse wave veloc-
ity and carotid-femoral pulse-wave velocity. (A) Boxplot comparing
AVF outcomes and augmentation indices; (B) Boxplot comparing
AVF outcomes and carotid-femoral PWV; (C) Boxplot comparing AVF
outcomes and brachial-radial pulse wave velocity (PWV).
© 2016 Wichtig Publishing
481
artery tonometry (PAT) index (ratio of results of brachial pulse
amplitude pre- and post-hyperaemia induction) found that
that the PAT index was associated with AVF FTM but not PWV
(10). In theory, stiffer brachial arteries should display less
“elastic recoil” thus explaining the observation of increased
FTM risk in the setting of a higher PAT index. The reason why
this does not translate into an association between FTM and
an increased brachial-radial PWV in our study requires fur-
ther exploration.
The Hemodialysis Fistula Maturation (HFM) Study group
recently reported the somewhat paradoxical finding that early
AVF thrombosis was associated with higher brachial artery
nitroglycerin-induced muscular dilation and lower carotid-
femoral PWV (18). More recently, the HFM study group have
published data from 602 individuals indicating that pre-
operative carotid-femoral PWV and carotid-radial PWV do not
correlate with ultrasound measurements of AVF blood flow
and diameter at six weeks post-AVF creation (19). The au-
thors found that greater pre-operative arterial nitroglycerin-
induced dilation and flow-mediated dilation were associated
with increased AVF blood flow and diameter at six weeks sug-
gesting that native arterial properties do influence AVF devel-
opment. Whether a correlation between arterial properties
and AVF functional outcomes exists in this cohort remains to
be seen. Arterial function and AVF maturation may be a far
more complex process than previously anticipated.
This study has a number of strengths and weaknesses.
Its strengths include the recording of both central (aortic)
and peripheral measurements of arterial stiffness and the
use of a device assessing both AI and PWV as recommend-
ed by previous work (20). Its weakness is the sample size
which limited the power of this pilot study. Northern Ire-
land has one of the highest live-donor transplant rates in
Europe. As a consequence of the increase in pre-emptive
live donor transplant activity, a smaller number of patients
than expected were referred for AVF creation and therefore
reduced the number of subjects eligible for recruitment.
It could be argued that the findings of this study are
less generalizable as “fitter” patients with ESRD were more
likely to have received a transplant than the individuals in
this pre-dialysis study population who had a higher burden
of co-morbidities. Nevertheless, this present study had a
larger sample size than previous publications (1, 10) re-
porting the associations of arterial stiffness and PWV with
AVF outcomes and the recruited patients reflect the nature
of patients that are increasingly referred to the vascular
access team.
Given the long observation period per patient, i.e., from
vascular access clinic assessment, followed by arterial param-
eter measurements prior to AVF surgery and then prolonged
follow-up to establish the functional clinical outcomes, a larg-
er sample size can only be achieved in a multicentre study on
a national level or as a multicentre European study.
The impact of arterial stiffness upon later AVF maturation
and longer-term patency is still incompletely understood.
­Despite having reasonable sized arterial and venous diame-
ters on pre-operative ultrasound mapping, up to 30% of AVFs
still fail for largely unknown reasons (5). This AVF FTM can
result in increased morbidity and higher mortality for those
individuals who end up starting dialysis with a central venous
482
c­ atheter. The AVF FTM in this population may be associated
with endothelial dysfunction coupled with vessel wall stiff-
ness in the feeding artery. Research is needed in this area as
any potential correlations between vascular biology, physio-
logical measurement and clinical outcomes may guide future
interventions.
The impact of vessel elasticity on AVF FTM is still an area of
active investigation and justifies studies in larger populations.
Disclosures
Financial support: Dr. Agnes Masengu is supported by a clini-
cal research fellowship provided by the Northern Ireland Kidney
Research Fund.
Conflict of interest: None of the authors has financial interest related
to this study to disclose.
References
1. Kheda MF, Brenner LE, Patel MJ, et al. Influence of arterial
elasticity and vessel dilatation on arteriovenous fistula matu-
ration: a prospective cohort study. Nephrol Dial Transplant.
2010;25(2):525-531.
2. Briet M, Boutouyrie P, Laurent S, London GM. Arterial stiffness
and pulse pressure in CKD and ESRD. Kidney Int. 2012;82(4):
388-400.
3. Sutton-Tyrrell K, Najjar SS, Boudreau RM, et al; Health ABC Study.
Elevated aortic pulse wave velocity, a marker of arterial stiffness,
predicts cardiovascular events in well-functioning older adults.
Circulation. 2005;111(25):3384-3390.
4. Claridge M, Wilmink T, Ferring M, Dasgupta I. Measurement
of arterial stiffness in subjects with and without renal disease:
Are changes in the vessel wall earlier and more sensitive mark-
ers of cardiovascular disease than intima media thickness and
pulse pressure? Indian J Nephrol. 2015;25(1):21-26.
5. Mancia G, De Backer G, Dominiczak A, et al; Management of
Arterial Hypertension of the European Society of Hyperten-
sion; European Society of Cardiology. 2007 Guidelines for the
Management of Arterial Hypertension: The Task Force for the
Management of Arterial Hypertension of the European Society
of Hypertension (ESH) and of the European Society of Cardiol-
ogy (ESC). J Hypertens. 2007;25(6):1105-1187.
6. McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft
JR; ACCT Investigators. Normal vascular aging: differential effects
on wave reflection and aortic pulse wave velocity: the Anglo-
Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005;46(9):
1753-1760.
7. McGreevy C, Barry M, Bennett K, Williams D. Repeatability of
the measurement of aortic pulse wave velocity (aPWV) in the
Arterial stiffness and fistula failure of maturation
clinical assessment of arterial stiffness in community-dwelling
older patients using the Vicorder(®) device. Scand J Clin Lab
Invest. 2013;73(4):269-273.
8. McIntyre NJ, Fluck RJ, McIntyre CW, Fakis A, Taal MW. Deter-
minants of arterial stiffness in chronic kidney disease stage 3.
PLoS ONE. 2013;8(1):e55444.
9. Thurn D, Doyon A, Sözeri B, et al; 4C Study Consortium. Aortic
Pulse Wave Velocity in Healthy Children and Adolescents: Ref-
erence Values for the Vicorder Device and Modifying Factors.
Am J Hypertens. 2015;28(12):1480-1488.
10. MacRae JM, Ahmed S, Hemmelgarn B, et al. Role of vascu-
lar function in predicting arteriovenous fistula outcomes:
an observational pilot study. Can J Kidney Health Dis. 2015;
2(1):19.
11. Chitalia N, Ross L, Krishnamoorthy M, et al. Neointimal hy-
perplasia and calcification in medium sized arteries in adult
patients with chronic kidney disease. Semin Dial. 2015;28(3):
E35-E40.
12. Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness
and risk of atherosclerotic events. Arterioscler Thromb Vasc
Biol. 2003;23(4):554-566.
13. Salvi P, Magnani E, Valbusa F, et al. Comparative study of meth-
odologies for pulse wave velocity estimation. J Hum Hyper-
tens. 2008;22(10):669-677.
14. DeLoach SS, Townsend RR. Vascular stiffness: its measurement
and significance for epidemiologic and outcome studies. Clin J
Am Soc Nephrol. 2008;3(1):184-192.
15. Georgiadis GS, Georgakarakos EI, Antoniou GA, et al. Correla-
tion of pre-existing radial artery macrocalcifications with late
patency of primary radiocephalic fistulas in diabetic hemodi-
alysis patients. J Vasc Surg. 2014;60(2):462-470.
16. Silva MB Jr, Hobson RW II, Pappas PJ, et al. A strategy for in-
creasing use of autogenous hemodialysis access procedures:
impact of preoperative noninvasive evaluation. J Vasc Surg.
1998;27(2):302-307, discussion 307-308.
17. Okon EB, Chung AW, Rauniyar P, et al. Compromised arterial func-
tion in human type 2 diabetic patients. Diabetes. 2005;54(8):
2415-2423.
18. Farber A, Imrey PB, Huber TS, et al; HFM Study Group. Mul-
tiple preoperative and intraoperative factors predict early fis-
tula thrombosis in the Hemodialysis Fistula Maturation Study.
J Vasc Surg. 2016;63(1):163-70.e6.
19. Allon M, Greene T, Dember LM, et al; Hemodialysis Fistula
­Maturation Study Group. Association between Preoperative
Vascular Function and Postoperative Arteriovenous Fistula De-
velopment. J Am Soc Nephrol. 2016 May 9. pii: ASN.2015020141.
[Epub ahead of print].
20. London GM, Blacher J, Pannier B, Guérin AP, Marchais SJ, Safar
ME. Arterial wave reflections and survival in end-stage renal
failure. Hypertension. 2001;38(3):434-438.
© 2016 Wichtig Publishing