Correlation between preoperative Doppler ultrasonography-assessed specific accessory cephalic vein diameter-cephalic vein diameter ratio (r) and early dysfunction of radial artery-cephalic vein arteriovenous fistula: a single-center cross-sectional study

Abstract

Background: Accessory cephalic vein (ACV) ligation can save immature arteriovenous fistula (AVF) of patients. However, no consensus has been reached on the definite timing of ACV ligation. To retrospectively analyze the correlation between preoperative Doppler ultrasonography (DUS)-assessed specific ACV diameter-cephalic vein diameter ratio (r) and early dysfunction of radial artery-cephalic vein arteriovenous fistula (RC-AVF).To improve the early maturity rate of RC-AVF.Methods: A total of 258 patients with RC-AVF diagnosed at the Vascular Surgery Center of the Third Affiliated Hospital of Sun Yat-sen University from 1 June 2018 to 31 March 2022, were included in this study. The inclusion criteria were as follows: (I) no DUS-confirmed vascular variation; (II) cephalic vein ≥2.0 mm and radial artery ≥1.5 mm, suitable for RC-AVF establishment; (III) presence of an ACV. As per the specific r determined using preoperative DUS assessment, all patients were classified into two groups: Group A and Group B. Furthermore, patients in each group were divided into intervention and non-intervention subgroups based on the presence or absence of intraoperative ACV ligation, respectively. Evaluate whether patients' age, sex, underlying disease, AVF side, radial diameter and other data can be compared. The difference of maturity rate between intervention group and non-intervention group with different r values was analyzed, so as to obtain the relationship between different r and maturity rate.Results: No statistical differences were observed between the intervention and non-intervention subgroups in the two groups in terms of sex, age, comorbidities, complications, AVF side, radial artery, cephalic vein, and ACV diameters (P>0.05). When r<0.8, the maturity rates of the intervention group and the nonintervention group were 80% and 92.98%, respectively, χ 2 =4.561. The difference in maturation rate between the intervention and non-intervention subgroups was insignificant (P=0.075>0.05) when r<0.8. When r≥0.8, the maturity rates of the intervention group and the non-intervention group were 89.83% and 45.45%, respectively, χ 2 =25.943. The difference in maturation rates between the intervention and non-intervention subgroups was significant when r≥0.8 (P<0.001).Conclusions: Preoperative DUS suggested a correlation between r≥0.8 and early immaturity of RC-AVF.Therefore, concurrent intraoperative ACV ligation should be carried out when preoperative r is ≥0.8 in order to reduce the early power dysfunction of RC-AVF.