Intraoperative venous distensibility can be used to predict arteriovenous fistula maturation

Abstract

Introduction: For decades, the diameters of the blood vessels have occupied an essential place in predicting AV fistula maturation. However, in addition to absolute vein diameters, vein distensibility has recently been correlated with AVF outcome.

Objectives: We assumed intraoperative measured vein distensibility using the saline solution can successfully predict fistula maturation.

Patients and methods: This study included 120 patients with native radiocephalic or brachiocephalic fistulas. Intraoperatively, the diameter of the blood vessels was measured. Consequently, we cut the vein, dilated it with a solution, and then measured it again. Distensibility was calculated as both absolute and relative values. The distance of palpable thrill from anastomosis was also measured. Two months after surgery, a Doppler examination was performed to assess fistula maturation.

Results: Cumulative maturation was 75.8% and was not significantly different between radio and brachiocephalic fistula. In brachiocephalic fistulas, a difference was found in the diameter of the vein (3.24 mm vs 2.61 mm) and the diameter of a dilated vein (4.69 mm vs 3.89 mm). In radiocephalic fistulas, a difference was in the following parameters: Artery (2.7 mm vs 2.4 mm), Dilated vein (3.93 mm vs 3.15 mm), Adis (1.73 mm vs 1.13 mm), Rdis (1.89 vs 1.59), and Thrill (14.2 cm vs 11.6 cm). The ROC curve analysis identified threshold values that predict successful fistula maturation. For RC AVF, it was (Artery 2.45 mm, Dilated vein 3.45 mm, Adis 1.25 mm, Rdis 1.65, and Thrill 14.5 cm), and for BC AVF, it was (Vein 2.85 mm, and Dilated vein 4.25 mm).

Conclusion: Intraoperative vein distensibility and thrill can be used to predict the maturation of radiocephalic fistulas. In brachiocephalic fistulas, vein distensibility has no predictive value. The only two intraoperative parameters for predicting brachiocephalic fistula maturation were the vein diameter before and after dilatation.

Keywords: AVF maturation; vein diameter; vein distensibility.