Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients.
BACKGROUND
The radiocephalic arteriovenous fistula (AVF), which provides the best vascular access for hemodialysis, continues to have a high incidence of early failure. Intimal hyperplasia (IH) of the radial artery is observed commonly in uremic patients before hemodialysis, but the impact of this preexisting IH on the early failure of radiocephalic AVFs has not been reported yet. Therefore, we designed this study to: (1) investigate clinical risk factors for IH, and (2) determine whether preexisting IH of the radial artery is associated with early failure of a radiocephalic AVF.


METHODS
Specimens from the radial artery were obtained during the radiocephalic AVF operation. IH was measured with trichrome staining, and AVF patency was prospectively followed up for 12 months after the operation.


RESULTS
Of the 59 patients, 45 patients had evidence of IH in their radial artery (76.2%). Patients with IH (n = 45) were older than those without IH (n = 14; 58 +/- 12 versus 44 +/- 17 years; P = 0.003). The incidence of diabetes mellitus in patients with IH was greater than that in patients without IH (60.0% versus 28.6%; P = 0.004). Of the 57 patients, except for 2 patients who died before the end point of the study with patent AVFs, fistula failure was observed only in patients with IH (22 of 44 patients; 50% versus 0%; P < 0.001). The intima was thicker in the failed-AVF group than the patent-AVF group (93.1 +/- 37.5 versus 45.6 +/- 17.4 micrometer P < 0.001).


CONCLUSIONS
This study suggests that early failure of radiocephalic AVFs in hemodialysis patients is closely associated with preexisting IH of the radial artery.
Kim
Young Ok
YO
Departments of Internal Medicine, Surgery, and Clinical Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Song
Ho Cheol
HC
Yoon
Sun Ae
SA
Yang
Chul Woo
CW
Kim
Nam Il
NI
Choi
Yeong Jin
YJ
Lee
Eun Jung
EJ
Kim
Wan Young
WY
Chang
Yoon Sik
YS
Bang
Byung Kee
BK
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000473:pathology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000473:pathology*; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology*; D014511:Uremia / Q000473:pathology