Role of perioperative vein diameter and flow volume change rate on predicting primary functional maturation of autogenous arteriovenous fistula

Abstract

Introduction The patients on regular hemodialysis prefer the arteriovenous fistula (AVF) as their vascular access for dialysis. The goal of AVF surgery was to increase the proportion of dialysis patients who use native AVFs. The success of AVF surgery is mainly dependent on the upper limb’s vasculature. Therefore, improved selection of the most appropriate procedure must be coupled with early access surveillance to determine which access would likely mature and when intervention might lead to access salvage. Aim This study aimed to determine the various vascular parameters (vein diameter and flow volume) both preoperatively and postoperatively at prespecified intervals − irrespective of other variables − for optimal hemodynamics of AVFs and their primary functional maturation. Materials and methods This prospective cohort study was conducted at Ain Shams University Hospitals on 80 patients with end-stage renal disease on regular dialysis submitted for autogenous AVF from November 2020 to November 2021. Cephalic vein diameter, basilic vein diameter, as well as both brachial and radial artery diameters, flow, and peak systolic velocity from the wrist to the proximal upper arm were all measured using ultrasound with Doppler preoperatively and postoperatively at postoperative day 1 (POD 1), 6 weeks, and 3 months. Results In all, 80 patients (54 brachiocephalic BC AVF, 18 radiocephalic RC AVF, 8 brachiobasilic BB AVF) were evaluated with a mean age of 54.65±12.24. The male : female ratio was 1 : 1.1. The etiology of renal failure was diabetes related in 36.3%, and the remaining 73.7% were nondiabetic. The overall maturation rate was 81.25%, with 18.75% failure to mature rate. In comparison between different groups of fistulas, a significant difference was found in comparing the preoperative and postoperative vascular diameter and flow rates between the groups. The mean preoperative cephalic vein diameter in mature RC AVF was 2.59±0.55 mm with the mean flow volume at POD 1 being 265.83±61.46 ml/min. The mean preoperative cephalic vein diameter in mature BC AVF was 3.21±0.70 mm with the mean flow volume at POD 1 being 311.79±93.25 ml/min. The mean preoperative basilic vein diameter in mature BB AVF was 3.08±0.95 mm with the mean flow volume at POD 1 being 319.60±45.67 ml/min. Conclusion On the basis of this study, flow volume at POD 1 can be used as a predicting factor for RC and BB AVF maturation. Also, perioperative vein diameter change can be used as a predictor for RC AVF maturation. However, none of these parameters can be used as a predicting factor for maturation in BC AVF. Therefore, further studies of large size are recommended to standardize these parameters.