Arterial and Venous Evaluation for Predicting Arteriovenous Fistula Functionality
Keywords:
arteriovenous fistula; haemodialysis; vascular access; radiocephalic fistula; brachiocephalic fistula; arterial diameter; venous diameter; maturation.Abstract
Background
Arteriovenous fistula (AVF) is the preferred form of permanent vascular access for most patients requiring maintenance haemodialysis because of its favourable long-term outcomes and lower infectious complications compared with central venous catheters [1,2]. However, failure of AVF maturation remains a significant clinical problem. Preoperative assessment of arterial and venous anatomy may help identify suitable vessels, guide access-site selection and improve the likelihood of successful fistula maturation [3-5].
Aim
To evaluate the role of preoperative arterial and venous diameter assessment in predicting AVF maturation and functionality.
Methods
A prospective cohort study was conducted among 50 patients with end-stage renal disease or advanced chronic kidney disease planned for first-time AVF creation. Patients aged 25–75 years were included. Patients with previous access failure, central venous stenosis, severe arterial calcification or venous thrombosis were excluded. Preoperative arterial and venous diameters were documented and correlated with AVF maturation. Radiocephalic (RC) and brachiocephalic (BC) AVFs were compared.
Results
The study included 50 patients, comprising 30 males (60%) and 20 females (40%), with a mean age of 55.2 ± 12.1 years. Twenty-one patients (42%) underwent RC AVF creation and 29 (58%) underwent BC AVF creation. Mean arterial diameter was 2.6 ± 0.4 mm and mean venous diameter was 2.5 ± 0.4 mm. Maturation success was 23% among patients with an arterial diameter of 1.5–2.0 mm compared with 68% among those with an arterial diameter >2.0 mm. The reported maturation rate was 66.7% for RC AVFs and 82.8% for BC AVFs, with a reported p value of 0.04.
Conclusion
Preoperative vascular assessment appears useful in predicting AVF maturation. Larger arterial calibre was associated with improved maturation, and BC AVFs demonstrated a higher reported maturation rate than RC AVFs. An arterial and venous diameter of approximately 2.0 mm or greater may be considered desirable during access planning, while access selection should remain individualized according to vessel characteristics and patient factors.
