Abstract
Arteriovenous fistulas are an important means of vascular access for long-term haemodialysis in patients with end-stage renal disease (ESRD). We evaluated the outcome of radiocephalic arteriovenous fistulas (RCAVFs) in 55 patients operated upon in our hospital in southern India. We studied the outcome of RCAVF surgery with the demographic factors, duration of diabetes, the diameter of the radial artery and cephalic vein, and any signs of atherosclerosis in the radial artery. We found that a small cephalic vein size of ≤ 2 mm, a negative cephalic vein tap test, a thickened, non-compressible, calcified radial artery on palpation, and evidence of atherosclerosis on radiological investigations were associated with a significant chance of RCAVF failure. A clinico-radiological grading of atherosclerosis for peripheral arteries is also proposed. Any patient presenting to the microsurgeon with a small cephalic vein size, a negative cephalic vein tap test, a thickened, non-compressible, calcified vessel on palpation, and tram-track calcification or whole vessel calcification or severely atherosclerotic vessel on radiological evaluation must be approached with caution regarding RCAVF creation and must be prepared for an arteriovenous fistula (AVF) creation at a higher level.
Highlights
Arteriovenous fistulas are an important means of vascular access for long-term haemodialysis in patients with chronic renal failure with end-stage renal disease (ESRD) [1]
We evaluated the outcome of radiocephalic arteriovenous fistulas (RCAVFs) in 55 patients operated upon in our hospital in southern India
We found that a small cephalic vein size of ≤ 2 mm, a negative cephalic vein tap test, a thickened, non-compressible, calcified radial artery on palpation, and evidence of atherosclerosis on radiological investigations were associated with a significant chance of RCAVF failure
Summary
Arteriovenous fistulas are an important means of vascular access for long-term haemodialysis in patients with chronic renal failure with end-stage renal disease (ESRD) [1]. Fistula survival has been shown to be influenced by the institution where the surgery is performed [7], operative factors (e.g., greater intraoperative doses of heparin), vein diameters, type of surgical suturing, and perioperative factors, such as hypotension during dialysis [8,9,10]. The radiocephalic type of arteriovenous fistulas are the first-line choices in most settings, meta-analysis has shown them to have lesser patency rates in the elderly compared to brachiocephalic AVF [13]. Maturation has been defined variously by ultrasound (e.g., having a blood flow rate greater than 500 mL/min), based on its structure/patency as fistulas with a diameter greater than 0.4 cm, or one that has successfully supplied adequate blood flow for hemodialysis [15]. We intend to observe the outcomes of RCAVF surgeries done by the hybrid suture technique (see below) and elucidate the effect of arterial and venous vessel diameter, as determined by clinical examination, preoperative investigations, and intraoperative measurements, as a factor for its success
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