The role of venous diameter in predicting arteriovenous fistula maturation: When not to expect an AVF to mature according to pre-operative vein diameter measurements? A best evidence topic

Abstract

This best evidence topic was investigated according to a described protocol. We asked the question: what is the minimal vein diameter that can successfully predict maturation of an arteriovenous fistula (AVF) in patients undergoing dialysis. Using the reported search 804 papers were found, of which five represented the best evidence to answer the clinical question. All studies assessed the association between successful AVF maturation and the size of vein used. The strongest evidence came from a nonrandomised controlled follow-up study in which 76% of fistulas created using >2 mm cephalic vein successfully matured compared to 16% when the vein measured ≤2 mm. Another prospective, multicentre study showed 65% successful maturation using veins >4 mm compared to 45% with veins <3 mm. Vein diameter was found to be an independent predictor of maturation in multivariate regression analysis in two retrospective observational studies. Another retrospective observational study found that using venous measurements of ≥2.5 mm following tourniquet application resulted in more fistulas been created that would have otherwise been denied based on venous ultrasound mapping. A large multicentre randomised clinical trial assessing the use of different vein sizes both with and without tourniquet application using proper statistical tools - such as receiver operating characteristic - is required to make a final recommendation. Until then, a vein diameter of <2.5 mm should be considered inadequate for formation of an AVF, particularly if those measurements remain unchanged following the use of tourniquet.

Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

“…Most previous reports assessing the association between failure of maturation and the size of the vein used showed findings consistent with our results [6,7]. Our study results lead us to recommend a cephalic vein of ≥2.45 mm (AUC, 0.70) in order to optimize the functional maturation outcomes.…”

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

“…Zadeh et al [62] conducted a cross-sectional study using a sample of 96 haemodialysis patients and found an association between the vein diameter and the success rate of fistula development. A vein diameter of <2.5 mm is supposed to be considered inadequate for formation of an AVF, particularly if measurements remain unchanged following the use of tourniquet [63].…”

Association of Preoperative Mean Arterial Pressure With the Primary Failure of Brescia‐Cimino Arteriovenous Fistula Within the First 7 Days Following Surgery in Hemodialysis Patients

“…In addition, cephalic vein diameter has been reported to be involved in AVF maturation. Indeed, Bashar et al showed that a cephalic vein <2.5 mm should be considered inadequate for AVF. Uy et al showed that in patients with small cephalic veins, isometric handgrip exercises could increase the diameter of the cephalic vein, making these patients eligible for AVF surgery.…”