Indian Journal of Vascular and Endovascular Surgery (Jan 2019)
Cross-sectional study of upper-limb vessel diameters and their association with arteriovenous fistula maturation in end-stage renal disease patients
Abstract
Introduction: For creation of upper-limb arteriovenous fistula (AVF), international guidelines recommend a minimum diameter of 2 mm for artery and 2 mm/2.5 mm for vein. However, there are no large-scale studies in Indian patients whose stature and built is different compared to Western population. The aim of this study was to understand the upper-limb vessel diameters and their effect on AVF maturation in Indian patients. Methods: All consecutive patients who underwent AVF creation between November 2018 and May 2019 were included in the study. Demographics, upper-limb vessel diameter, type of surgery, and maturation rate at 6 weeks were recorded. Results: 129 patients were included with a mean age of 44 years (range, 18–80 years). Eighty-nine out of 129 patients (69%) were men. Overall, the mean diameter was 2.5 (range, 1–4.6 mm), 4.63 (range, 1.4–8.6 mm), 2.15 (range, 1–4.8 mm), and 3.13 mm (range, 1–6.8 mm) in the radial artery, brachial artery, and cephalic vein at wrist and elbow, respectively. In the 76 patients who underwent radiocephalic (RC) fistula, the mean diameter was 2.56 (range, 1.4–4.6 mm), 4.68 (range, 2.1–8.6 mm), 2.1 (range, 1–4.8 mm), and 3.0 mm (range, 1–5.9 mm) in the radial artery, brachial artery, and cephalic vein at wrist and elbow, respectively. In the 54 patients who underwent brachiocephalic (BC) fistula, the mean diameter was 2.3 (range, 1–4.3 mm), 4.5 (range, 1.4–6.9 mm), 1.6 (range, 1–3.6 mm), and 3.3 mm (range, 1.4–6.8 mm) in the radial artery, brachial artery, and cephalic vein at wrist and elbow, respectively. At 6 weeks, the maturation rate was 89.1% and 93.2% for RC and BC, respectively. Conclusion: The mean diameter of the cephalic vein at wrist and elbow was significantly less compared to Western population. Following the international guidelines would have taken away the opportunity to have a distal AVF in majority of the Indian patients requiring renal access patients 42 out 64 patients (65%).
Keywords
