The Impact of Patient Demographics, Anatomy, Comorbidities, and Peri-operative Planning on the Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula

Abstract

The aim of this study was to evaluate the collective and/or independent impact of patient demographics, comorbidities, anatomical factors, and peri-operative parameters on the primary functional maturation of RCAVFs. This study also aimed to identify the range and best cut off value for each variable and evaluate the likelihood, significance and percentage of primary functional maturation of RCAVFs. This was a prospective consecutive single centre cohort study over a 4 year period; it was conducted on patients with the intention-to-treat using a radiocephalic arteriovenous fistula (RCAVF) (Brescia-Cimino). During this period 548 vascular access procedures, inclusive of RCAVF, were performed. Variables included patient demographics (age, gender), anatomical variance (cephalic vein, radial artery diameter, laterality), comorbidities (diabetes mellitus, ischaemic heart disease, congestive cardiac failure, hypertension), aetiology of renal failure, and anaesthesia type (local versus general anaesthesia). Of the total, 324 patients, cephalic vein diameter > 1.5mm (OR 4.57, 95% CI, 2.42-8.63, p<.001) (non-augmented) and radial artery diameter>1.6mm (OR 12.26, 95% CI, 6.27-23.97, p<.001) were found to be independently associated with the primary functional maturation of 86% in the RCAVF formation. Of all the variables, cephalic vein and radial artery diameter are independently associated with the primary functional maturation of RCAVFs.