Evaluation of Factors Affecting Wrist Radio-Cephalic Arteriovenous Fistula Maturation: A Single Institutional Observational Study

Abstract

Background: Chronic renal failure is the most common indication for which arterio-venous (AV) fistula creation surgery is being performed. Various studies have found that native arteriovenous fistulas are the best in long-term patency with lower complications. We conducted this study to find out the role of preprocedural duplex ultrasound (DUS) in predicting outcomes of radio-cephalic fistula in the wrist in the North-Karnataka population. Methods: This prospective study was conducted from May 2019 to July 2020 on 50 patients who were hemodialysis-dependent and underwent AV fistula creation with age from 20 to 70 years. All the patients underwent preoperative DUS and were followed up post-operatively after one, two, and six weeks. Hemodialysis was initiated through the constructed fistula once it was mature, and the maximum blood flow through the fistula was measured. SPSS version 20.0 was used for statistical analysis. Results: Among 50 subjects, the overall cumulative success of AVF maturation was 86% (43), and failure to mature rate was 14% (7). Logistic regression of maturation outcome in the wrist autologous arteriovenous fistula for individual factors showed statistically significant results (P < 0.05) for the diameter of the radial artery > 1.6 mm and the distensibility of the cephalic vein > 0.4 mm. Conclusions: Vein distensibility and radial artery diameter are key factors in predicting successful AVF maturation. The use of intraoperative papaverine instillation directly on vessels can improve arteriovenous fistula outcomes.