The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients

Abstract

This study was performed to investigate the impact of intima-media thickness (IMT) of radial artery on early failure of radiocephalic arteriovenous fistula (AVF) in hemodialysis (HD) patients. Ninety uremic patients undergoing radiocephalic AVF operation were included in this study. During the operation, 10-mm long partial arterial walls were removed with elliptical form for microscopic analysis. Specimens were stained with trichrome and examined by a pathologist blinded to the clinical data. And then AVF patency was followed up for 1 yr after the operation. Of the total 90 patients, 31 patients (34%) had AVF failure within 1 yr after the operation. Mean IMT was thicker in failed group (n=31) than in patent group (n=59) (486+/-130 micrometer vs. 398+/-130 micrometer, p=0.004). The AVF patency rate within 1 yr after the operation was lower in patients with IMT > or = 500 micrometer (n=26) than in patients with IMT <500 micrometer (n=64) (p=0.017). Age was an independent risk factor of IMT. Diabetes mellitus tended to be independent risk factor but not statistically significant. Our data suggest that increased radial artery IMT is closely associated with early failure of radiocephalic AVF in HD patients.

Fig. 1

Comparison of intima, media, and intima-media thickness (IMT) between failed (n=31) and patent groups (n=54). Of the total 90 patients, 5 patients who died with patent AVF before the study end point were excluded. ^*,p<0.001; ^†,p=0.042; ^‡,p=0.004 versus patients with patent group by Student's t test.

Fig. 2

Comparison of AVF patency rate between patients with IMT ≥500 µm (n=26) and <500 µm (n=64). Five patients who died with patent AVF before the study end point were included as censored data. p=0.017 versus patients with patent group by Kaplan-Meier method with Log Rank test.