American Board of Internal Medicine (ABIM) Certification Practice Exam

What complication is most relevant for patients requiring arteriovenous fistula (AVF) placement prior to hemodialysis?

1. Infection

2. Delayed maturation of the fistula

3. Thrombosis

4. Vascular occlusion

The correct answer is: Delayed maturation of the fistula

The most relevant complication for patients requiring an arteriovenous fistula (AVF) placement prior to hemodialysis is delayed maturation of the fistula. Delayed maturation refers to the inability of the fistula to develop adequate blood flow and functionality in a timely manner for effective access during hemodialysis procedures. For an AVF to be utilized for hemodialysis, it needs to mature enough to provide sufficient blood flow, typically reaching a target of at least 600 mL/min. This maturation process can take weeks to months following the surgical creation of the fistula. If the fistula does not mature adequately, patients may experience delays in starting hemodialysis, leading to potential adverse health outcomes due to insufficient renal replacement therapy. While complications such as infection, thrombosis, and vascular occlusion can occur with AVF placement and usage, the issue of delayed maturation is particularly significant because it directly affects the timelines for initiating hemodialysis. If an AVF is not mature when needed, alternative forms of access, such as central venous catheters, may have to be employed temporarily, which carry their own risks and complications. Recognizing the importance of delayed maturation helps healthcare providers manage patient expectations and plan for