Influence of Arterial and Venous Diameters on Autogenous Arteriovenous Access Patency

Abstract

The autogenous arteriovenous fistula (AVF) is the standard procedure for patients requiring chronic hemodialysis. To enhance its success, preoperative duplex ultrasound has been used to determine fistula location based on venous and arterial diameters. Previous authors have suggested that a minimum outflow vein diameter (MOVD) and perianastomotic arterial diameter are associated with successful maturation. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. AVFs created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of venous and arterial diameters and demographic and clinical variables were collected. Kaplan-Meier and Cox hazards analysis were used to assess patencies and maturation and to identify independent predictors of access failure. There were 535 AVFs were created (median follow-up, 17.0 months; range, 0-73 months). Of these, 265 (49.5%) were radiocephalic, 221 (41.3%) were brachiocephalic, and 49 (9.2%) were brachiobasilic. AVFs with an MOVD <3 mm were associated with inferior primary patencies at 12 months (43% ± 4% vs 54% ± 4%; P = .009) and 36 months (19% ± 4% vs 33% ± 4%) and secondary patencies at 12 months (75% ± 3% vs 91% ± 2%; P < .001) and 36 months (63% ± 4% vs 78% ± 4%; P < .001). Arterial diameter <2 mm for radiocephalic AVFs was associated with impaired maturation at 12 months in diabetics vs nondiabetics (53% ± 9% vs 87% ± 8%), with no differences observed in maturation rates with radial artery diameters >2 mm (84% ± 5% vs 85% ± 4%; P =.019). On multivariate regression, MOVD (hazard ratio [HR], 0.02; 95% confidence interval [CI], 0.01-0.23; P = .002), female sex (HR, 1.75; 95% CI, 1.12-2.73), and diabetes (HR, 1.67; 95% CI, 1.00-2.79; P =.048) were associated with secondary patency loss. MOVD is strongly predictive of autogenous access patency. Radial artery diameter <2 mm was predictive of radiocephalic AVF failure to mature, but only in diabetic patients.