Clinical observation on the vascular remolding in the wrist autogenous arteriovenous fistula

Objective To explore the changes of vascular remodeling in the mature period after the establishment of the wrist autogenous arteriovenous fistula.Methods Sixty-two patients with end-stage renal disease were enrolled and 55 patients finished flow-up investigation. Smoking habit, diabetes history and artery calcification evaluated by X ray on forearm were recorded. Before fistula operation, radial artery and cephalic vein were evaluated by ultrasound. In the first day after operation, blood flow directions near the fistula anastomosis were explored by ultrasound. One month and three months after fistula operation, radial artery and cephalic vein were measured by ultrasound again. Distal ischemia was evaluated 3 months after operation.Results The operation of arteriovenous fistula was successful in all patients. Three months after operation, three un-matured fistulas were diagnosed and the fistula matured rate was 94.5%. ANOVA showed significant differences in radial artery and cephalic vein before, one and three months after operation (P<0.01). Increasing trend in radial artery and cephalic vein diameter could be seen. The steal rate of fistula was 94.5% and 10 patients were diagnosed as having hemodialysis access-induced distal ischemia (HAIDI). There was no significant correlation between steal phenomenon and HAIDI (P=0.484). There was no intimal hyperplasia in fistula one month after operation, but 3 months after operation, there were 15 patients suffered from intimal hyperplasia in cephalic vein. Three patients were diagnosed as having fistula stenosis.Conclusions After wrist arteriovenous fistula operation, the inner diameters of radial artery and cephalic vein became larger. The changes in one month after operation were most obvious. Steal phenomenon of fistula was common in arteriovenous fistula. Intimal hyperplasia in cephalic vein could lead to fistula un-maturation.