Venous distensibility is more important than venous diameter in primary survival of autogenous radiocephalic arteriovenous fistulas

Abstract

Background: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. Methods: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. Results: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893–49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033–0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. Conclusion: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

“…Exposing the vein to this arterial environment necessarily requires physiologic vessel dilation and remodeling of the vein wall [ 16 , 17 ]. Indeed, a retrospective study by Hou et al found venous distensibility to be predictive of AVF patency and usability in patients requiring hemodialysis, even more so than the baseline venous diameter, suggesting the importance of venous adaptability [ 18 ].…”

Modified no-touch technique for radio-cephalic arteriovenous fistula increases primary patency and decreases juxta-anastomotic stenosis

“…According to previous studies, cephalic vein diameter of ⩽2.0 mm have high RC-AVF failure rates. 19 In our study, only two patients in the MNTT group lost patency, and the effect of venous diameter on the patency of AVF was more likely to be meaningful for patients in the conventional surgery group (control group). Large samples and long-term follow-up were needed to confirm whether the patency of AVF in MNTT cohort patients was affected by venous diameter.…”

The feasibility and efficiency for constructing arteriovenous fistula with <2 mm vein—a systematic review and meta-analysis

“…Small venous diameter mean that the probability of anastomotic stenosis was higher, and it was more difficult to achieve the expected fistula diameter, flow rate and flow volume. Although the subgroup analysis indicated the tourniquet using did not influence the results, the venous distensibility played an essential role in the maturation rate of AVF, even more important than vein diameter (40). After AVFs were formed by anastomosis with arteries, the veins with good elasticity were gradually expanded under the shear stress of high-pressure arterial blood, which can quickly meet the requirements for dialysis.…”