Correlation between preoperative vein diameter and maturation of radiocephalic fistula

Abstract

INTRODUCTION: Autogenous arteriovenous fistula (AVF) is the optimal vascular access for hemodialysis and radiocephalic fistula is recommended as the first choice for primary AVF if the vascular anatomy is suitable. Preoperative venous mapping with ultrasound is recommended before autogenous AVF creation. Despite of routine preoperative mapping, the incidence of maturation failure remains high. PURPOSE: The aim of this study was to investigate variables that affect autogenous radiocephalic AVF maturation. Especially, we focused on the influence of pre-operative vein size on fistula maturation. METHODS: This was a retrospective analysis of patients underwent hemodialysis access creation from June 2013 to June 2015 at a single medical center. Preoperative vessel mapping was performed with ultrasound. The patients were allocated to two groups according to maturation outcome. Comparison of the variables between the two groups was performed using SPSS statistics. RESULTS: A total of 43 patients were included in the study cohort. The mean age was 51.8 ± 14.9 years old (range 21 to 72). A total of 26 patients (60%) were already on hemodialysis using a temporary central vein catheter. The mean diameter of cephalic vein was 2.4 ± 0.5 mm (range 1.5 to 4.0 mm). The radial artery was 2.3 ± 0.4 mm in diameter (range 1.6 to 3.5 mm). Primary functional maturation was achieved in 32 patients (32/43, 74%), while secondary fistula maturation rate was 79% (34/43). The mean duration of follow-up was 12.6 ± 7.5 months. There was no statistical significant between the matured and un-matured group in terms of age, gender, body-mass index, diabetes and prior dialysis catheter placement. However, patients with failure maturation had a significantly small vein diameter (P=0.025). CONCLUSIONS: Cephalic vein in Chinese patient was relatively smaller. Our study shows increased vein diameter on preoperative ultrasound mapping is associated with fistula maturation.