Influence Of Intraoperative Artery And Vein Diameters On Patency Of Autogenous Arteriovenous Fistula In Maintenance Hemodialysis Patients

Objective:To observe the effect of intraoperative measurement of artery diameter and vein diameter on the maturation of autogenous arteriovenous fistula(AVF),to investigate the optimal threshold for small diameter veins and to compare postoperative patency.METHODS:We selected maintenance hemodialysis patients who underwent AVF for the first time in the Department of Nephrology of the First Affiliated Hospital of Nanchang University from May 01,2020 to September 30,2021 and met the inclusion criteria for this retrospective study.Patients were followed up for at least 1 year after the procedure.Patients were divided into a functional maturity group and immature group according to whether or not their AVF was functionally mature.Patients were divided into a non-extra intervention group and an extra intervention group according to whether they had extra intervention or not.Gender,age,comorbidities,intraoperative artery diameter,intraoperative vein diameter,peak systolic velocity of the surgical artery and peak systolic velocity of the brachial artery on the surgical side were recorded for the included study subjects.Binary logistic regression analysis was performed to determine the risk factors for immature AVF and additional interventions.The optimal cut-off value for venous diameter was determined according to the receiver operating curve(ROC)and the Youden index.Patients were divided into two groups using the optimal cut-off value and Kaplan-Meier analysis was performed to further compare postoperative patency rates.RESULTS:A total of 336 patients with MHD were included.The mean age was 58.37 ±12.68 years.Surgical arterial and venous diameters were 2.19±0.53 mm and1.98±0.48 mm,respectively.Intraoperative arterial diameter may not be a factor in AVF maturation.Small diameter veins were a risk factor for functional AVF maturation failure and additional intervention(OR 0.334,95% CI 0.139-0.801,p=0.014;OR 0.405,95% CI 0.205-0.803,p=0.010).The optimal cut-off point for vein diameter was 1.85 mm when specificity and sensitivity reached 62.5% and62.5%,respectively.AVF with vein diameter ≥ 1.85 mm showed higher primary patency(P=0.028),primary assisted patency(P=0.005)and secondary patency(P=0.034).Conclusions:Arterial diameter may not be a factor in immature AVF.Small diameter vein is an independent risk factor for immature AVF and additional interventions.After a thorough and accurate preoperative vascular assessment,repeated intraoperative blunt needle probe dilation,aggressive postoperative exercise,enhanced doppler ultrasound(DUS),application of balloon-assisted maturation(BAM)when necessary,and use of veins of 1.85 mm or greater,AVF establishment can result in satisfactory functional maturation and postoperative patency.