Intima‐media thickness of radial artery is associated with early access failure in hemodialysis patients

Abstract

Objective: We have reported that intimal hyperplasia, which is the pathologic change of the radial artery, is associated with early failure of arteriovenous fistula (AVF) in hemodialysis (HD) patients (Am J Kidney Dis, 41:422–428, 2003). Intima‐media thickness (IMT), which represents the whole thickness of arterial wall, can be easily measured by ultrasonography, unlike intima thickness. This study was performed to investigate the impact of IMT of radial artery on early failure of AVF in HD patients. Methods: Ninety HD patients undergoing radiocephalic AVF operation were included in this study. The AVF was constructed in an end vein–to–side artery fashion at the wrist by one vascular surgeon. During the operation, 10‐mm long partial arterial walls were removed with elliptical form for microscopic analysis. Specimens were stained with trichrome and examined by a pathologist blinded to the clinical data. AVF patency was prospectively followed up for 1 year after the operation. Results: Mean age of the patients was 56 ± 13 years and the number of females was 44 (48.9%). Mean IMT was 430 ± 132 μm (133–760 μm). Of the total 90 patients, 31 patients (34.4%) had AVF failure within 1 year after the operation. Mean IMT was higher in the failed group (n = 31) than in patent group (n = 59)(486 ± 130 μm vs. 330 ± 178 μm, p = 0.004). Using a threshold of 500 μm of IMT, AVF patency rate was compared between these two groups using Kaplan‐Meier method with log rank test. The AVF patency rate within 1 year after the operation was higher in patients with IMT ≥ 500 μm (n = 26) than in patients with IMT < 500 μm (n = 64)(p < 0.001). The patients with IMT ≥ 500 μm were older and had higher incidence of diabetes mellitus, compared to the patients with IMT < 500 μm. There was no difference in sex, smoking, hypertension, total cholesterol and albumin levels between the two groups. Conclusion: Our data suggest that increased intima‐media thickness of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients.