The difference in diameter between radial artery and cephalic vein correlates with primary patency of radio-cephalic arteriovenous fistula

Abstract

Introduction:

Autogenous radio-cephalic arteriovenous fistula (RCAVF) is preferred for chronic hemodialysis access. However, RCAVF still suffers from disappointing survival due to fistula dysfunction, with intimal hyperplasia (IH) as an underlying cause of this condition. The inconsistency of radial artery diameter (D_RA) and cephalic vein diameter (D_CV) is one of the factors affecting the shear disturbance, which is believed to trigger the onset of IH. However, there are no reports correlating the difference in D_RA and D_CV with RCAVF outcomes.

Methods:

This was a retrospective cohort study. Consecutive patients (n = 233) with a new RCAVF created were included if they underwent duplex ultrasound examination to evaluate preoperatively the radial artery diameter (D_RA) and cephalic venous diameter (D_CV). We then calculated radial artery-cephalic vein diameter difference (D_CV minus D_RA, termed D_CV-D_RA hereafter) and evaluated the association of the preoperative D_CV-D_RA with primary patency of RCAVF at 12 months. Subgroup analysis was also performed to explore effect modification by age, gender, radial artery diameter, and cephalic vein diameter with D_CV-D_RA.

Results:

After adjusting for age, gender, weight, and mean arterial pressure, the preoperative D_CV-D_RA was associated with primary patency of RCAVF at 12 months (adjusted Odds ratio [aOR], 1.524 per 1-mm increase; 95% confidence interval [95% CI], 1.048–2.218). The primary patency of RCAVF at 12 months was achieved in 69.4%, 71.8%,and 87.3% of patients with a preoperative D_CV-D_RA of ⩽−0.6 mm, (−0.5)–0.5 mm, and ⩾0.6 mm, respectively. P for trend was 0.029. Patients with D_CV-D_RA of ⩾0.6 mm had a much higher chance of 12-month patency than patients with D_CV-D_RA of ⩽−0.6 mm (aOR, 3.574; 95% CI, 1.276–10.010). Age, gender, radial artery diameter, and cephalic vein diameter did not modify the association of D_CV-D_RA with primary patency of RCAVF at 12 months.

Conclusions:

Preoperative D_CV-D_RA may be an under-recognized predictor of RCAVF patency.