The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study

Abstract

ObjectiveAutogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small-caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation.DesignThis is a single-center retrospective study.MethodPatients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied the eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on the receiver operating curve (ROC) and the Youden index. Kaplan–Meier analysis was utilized in further patency rate comparisons.ResultA total of 125 forearm AVFs were created in 121 patients with end-stage renal disease (ESRD). The mean age was 53.88 ± 15.10 years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17 ± 0.54 and 1.71 ± 0.75 mm, respectively. Small-caliber vein is the risk factor for functional maturation failure (OR = 0.256, 95%CI [0.06–0.75], p = 0.033) and additional intervention (OR = 0.306, 95% CI [0.09–0.78], p = 0.031). The optimal cutoff value is 1.35 mm (augmented) when specificity and sensitivity reach 80 and 63.7%, respectively. The AVFs with a vein diameter of more than 1.35 mm (augmented) showed higher patency rates (p < 0.01).ConclusionAfter comprehensive DUS evaluation, intraoperative hydrodilation, postoperative active exercise and intensive DUS detection, and application of balloon-assisted maturation, if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.

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

“…The result indicated no significant difference between patients with different vein diameter. Hence, we reasonably believed that the long-term patency rates of AVF with vein less than 2 mm and larger than 1.35 mm ( 23 ) especially nearby 2 mm were satisfactory with the assistance of regular postoperative ultrasound and early balloon assisted maturation or secondary intervention if necessary. There were some limitations in this study.…”

“…Among these, most of cases were constructed with radio-cephalic AVF except 11 cases with brachial-cephalic AVF and 5 cases with brachial-basilic AVF. Based on NOS evaluation, 6 of 8 included articles were assessed as high quality and 4 of them reached the maximum score of 9 ( 18 , 20 – 23 ) ( Supplementary Table S1 ).…”

“…Two hundred ninetysix articles were excluded for lacking comparison on functional maturation rates between different vein diameters, 67 for involving synthetic graft, 8 for unexpected diameter threshold and 5 for non-English articles. Finally, 8 articles were included in this systematic review and meta-analysis (16)(17)(18)(19)(20)(21)(22)(23). The basic characteristic of all included articles was showed in Table 1.…”

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and Chang G (2023) The feasibility and efficiency for constructing arteriovenous fistula with <2 mm vein-a systematic review and meta-analysis.

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