title: Accessory veins and radial-cephalic arteriovenous fistula non-maturation: a prospective analysis using contrast-enhanced magnetic resonance angiography.
abstract: OBJECTIVE
  To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation.
  
  
  METHODS
  RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter > 2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n = 4), venous stenosis (n = 3) or both (n = 2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p = 0.01). Preoperatively detected accessory veins with a diameter > 70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9).
  
  
  CONCLUSIONS
  Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.
authors.affiliation: Department of Vascular Surgery, Maastricht University, Maastricht, The Netherlands. nilsplanken@gmail.com
authors.forename: R N
authors.initials: RN
authors.lastname: Planken
authors.forename: L E
authors.initials: LE
authors.lastname: Duijm
authors.forename: A G
authors.initials: AG
authors.lastname: Kessels
authors.forename: T
authors.initials: T
authors.lastname: Leiner
authors.forename: J P
authors.initials: JP
authors.lastname: Kooman
authors.forename: F M
authors.initials: FM
authors.lastname: Van Der Sande
authors.forename: J H M
authors.initials: JH
authors.lastname: Tordoir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003287:Contrast Media; D004106:Dilatation; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008026:Ligation; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D017534:Radial Artery / Q000473:pathology / Q000601:surgery*; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D013997:Time Factors; D017211:Treatment Failure; D014680:Veins / Q000473:pathology / Q000601:surgery*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA