Factors Affecting the Patency of Radiocephalic Arteriovenous Fistulas Based on Clinico-Radiological Parameters

Abstract

Arteriovenous fistulas are an important means of vascular access for long-term haemodialysis in patients with end-stage renal disease (ESRD). We evaluated the outcome of radiocephalic arteriovenous fistulas (RCAVFs) in 55 patients operated upon in our hospital in southern India. We studied the outcome of RCAVF surgery with the demographic factors, duration of diabetes, the diameter of the radial artery and cephalic vein, and any signs of atherosclerosis in the radial artery. We found that a small cephalic vein size of ≤ 2 mm, a negative cephalic vein tap test, a thickened, non-compressible, calcified radial artery on palpation, and evidence of atherosclerosis on radiological investigations were associated with a significant chance of RCAVF failure. A clinico-radiological grading of atherosclerosis for peripheral arteries is also proposed. Any patient presenting to the microsurgeon with a small cephalic vein size, a negative cephalic vein tap test, a thickened, non-compressible, calcified vessel on palpation, and tram-track calcification or whole vessel calcification or severely atherosclerotic vessel on radiological evaluation must be approached with caution regarding RCAVF creation and must be prepared for an arteriovenous fistula (AVF) creation at a higher level.

The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review

“… Plain forearm radiographs with visible arterial calcifications (arrows, graded as <6 cm in length, panel ( A ), and >6 cm, panel ( B ); reproduced from [ 8 ] (CC BY 4.0)). …”

“…The presence of arterial calcifications worsens the prognosis of patients with CKD and increases the likelihood of cardiovascular events [ 4 , 5 ]. Furthermore, arterial calcifications also reduce the possibility of arterio-venous fistula (AVF) formation and maturation and increase the likelihood of complications, especially distal ischemia [ 6 , 7 , 8 , 9 ]. This is a significant disadvantage, as an AVF is the optimal vascular access for patients on maintenance hemodialysis and is thus their lifeline.…”

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study

“…For over the two million people who require hemodialysis each year arteriovenous fistulae (AVF) remains the method to gain the permeant vascular access, it has been recognized as the primary and best option. 1 When compared to prosthetic arteriovenous grafts (AVG) and central vein catheters (CVC), AVF have low infection rates, fewer chances of rehospitalization to revise the access, and lower chances of thrombus formation. Furthermore, it has been documented that patients with an AVF have significantly reduced mortality rates and longer life expectancies.…”

Percutaneous ecoguided endovascular lithotripsy to recruit failed-to-mature arteriovenous fistula due to completely calcified radial artery

“…Preoperative ultrasound venous mapping has been proven to significantly aid the decision of placing an AVF that will have better odds of successful maturation. [7][8][9] The size of vessels or preexisting stenotic lesions of artery or vein are no longer considered absolute exclusion criteria for the creation of distal AVF. Some authors use routinely vessels pre dilatation before the creation of anastomosis to build distal AVF with small vessels 10 and intraoperative transluminal angioplasty to treat in advance stenotic vein or artery that could be major cause of EF or FTM.…”