Predictive factors for arteriovenous fistula maturation: A prospective study.

Abstract

Introduction: Arteriovenous fistula (AVF) maturation failure remains common despite preoperative ultrasound mapping. Identifying predictive biomarkers can help anticipate primary failure and reducing invasive procedures. Our study aimed to identify clinical and analytical risk factors for primary AVF failure or delay.

Methods: A prospective study (October 2022-March 2023) included adult patients scheduled for AVF creation. In all patients, a preoperative ultrasound mapping was conducted and AVF maturation assessed at least 6 weeks post-surgery. Clinical, analytical, and demographic data were collected.

Findings: Eighty patients were included, 62.5% male, and mean age 66.3 years. For distal anastomosis, preoperative vein (3.8 ± 1.2 vs. 2.8 ± 0.6 mm; p 0.002) and supply artery (2.5 ± 0.4 vs. 2.0 ± 0.3 mm; p 0.001) diameters were significant factors impacting primary failure. Also, for proximal anastomosis, the artery diameter (2.4 ± 0.4 vs. 2.0 ± 0.4 mm; p 0.01) had an impact on AVF maturation. ROC curves established for distal AVF a vein diameter cutoff of 3.25 mm (AUC 77.2%) and artery cut-off of 2.35 mm (AUC 74.6%) and for proximal AVF an artery cutoff of 2.25 mm (AUC 76.5%). Distal AVF creation correlated with higher primary failure risk (p < 0.001). No correlation was found between the primary failure rate and the presence of central venous catheter or serum results. In a sub analysis, we found that patients with central venous catheter had higher levels of inflammatory markers.

Discussion: Our study highlights the importance of preoperative evaluation, ultrasound mapping, and careful AVF site selection. Recognizing vein and artery diameter thresholds for optimal outcomes is crucial. Avoiding central venous catheters in suitable patients can positively impact AVF results.