Correlation between pathological changes of cephalic vein and radio-cephalic arteriovenous fistula maturation

Objective To explore the risk factors affecting the maturation of wrist radialcephalic arteriovenous fistula(RCAVF).Methods A total of 165 RCAVF patients were recruited.The study outcome of wrist RCAVF maturation was defined as a wrist RCAVF for at least six consecutive hemodialysis sessions with two-needle cannulation and a blood flow rate>200 mL/min.Retrospective reviews were conducted for demographic data,laboratory tests,preoperative vascular ultrasound examination and pathological changes of cephalic vein.Results There were 135 cases in maturation group and 30 in dysfunctional group.In maturation group,the proportion of patients with non-diabetic nephropathy was high(χ²=15.311,P=0.000),the preoperative radial artery calcification rate low(χ²=4.418,P=0.036),the internal diameter of cephalic vein large(t=-2.661,P=0.009) and the preoperative RI of radial artery low(t=2.182,P=0.031).Patient age was a risk factor for intimal hyperplasia of cephalic vein(t=3.294,P=0.001).Binary logistic regression analysis indicated that diabetes mellitus(OR=0.26,95%CI 0.09~0.70,P=0.008) and cephalic vein diameter(OR=0.29,95%CI 0.12~0.73,P=0.009) were independent risk factors.ROC curve analysis showed that the area under the curve of cephalic vein diameter was 0.653 and the optimal cut-off value 2.005 mm.Conclusions Small cephalic vein diameter and diabetes mellitus are independent risk factors for failed wrist radiocephalic arteriovenous fistulas.However,preoperative cephalic vein intimal hyperplasia and other morphological changes may not be correlated with wrist RCAVF maturation.