The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis

Abstract

Among patients undergoing radiocephalic AVFs, a tourniquet derived cephalic vein diameter <4.3 mm was the single independent predictor of inferior secondary and functional secondary patency. Among patients undergoing brachiocephalic AVFs, all patency rates were inferior in the presence of a brachial artery diameter ≤4.1 mm and secondary patency was inferior in the presence of multiple risk factors.

Is There an Accurate Pre-operative Criterion for Dialysis Access Artery or Vein diameter?

“…7 The present study by Kakkos et al used routine tourniquet derived cephalic vein measurements, the benefit of which remains unproven. 4 Though widely recommended, even duplex mapping did not improve functional AVF patency in a recent systematic review. 2 The study by Kakkos et al found that veins 4.2 mm had inferior functional patency for radiocephalic (RC)-AVF.…”

“…Early thrombosis accounted for only 5% with a multiplicity of aetiologies responsible for the remaining failures. 1,4 Research has focused on improving functional patency.…”

“…3,5 While radial arterial diameters 2.0 mm had no effect, a brachial artery diameter of 4.1 mm resulted in inferior functional patencies. 4 A palpable pulse and a radial diameter 2 mm remain widely accepted for RC-AVF. 4e6 Because there are few data on the effect of brachial diameter on BC-AVF outcome, it is difficult to explain why it should be different from a RC-AVF.…”

“…2 The study by Kakkos et al found that veins 4.2 mm had inferior functional patency for radiocephalic (RC)-AVF. 4 Without information about the cephalic arch, it is difficult to determine if outflow issues affected brachiocephalic (BC) outcomes. A 2009 study found vein diameter to be the sole independent predictor of functional fistula maturation and recommended 4 mm, similar to the recommendation of Kakkos et al 3 However, the minimum vein diameter 2.5 mm is still widely used.…”

Role of peribrachial fat as a key determinant of brachial artery dilatation for successful arteriovenous fistula maturation in hemodialysis patients

“…Adequate fistula maturation might be closely associated with an optimal dilation of the brachial artery after fistula creation 10 . The brachial artery is usually the main feeding artery of the AVF, either directly (upper arm AVF), or through the radial artery (forearm AVF).…”