Vein diameter after intraoperative dilatation with vessel probes as a predictor of success of hemodialysis arteriovenous fistulas.
BACKGROUND
Vascular access is "the life line" for patients on chronic hemodialysis. The autogenous arteriovenous fistula provides the best access to the circulation because of low complication rate, long-term use, and lower cost, compared to arteriovenous graft and central venous catheter. The primary objective of this prospective study was to investigate the predictive value of vein diameter after intraoperative dilatation with vessel probes on hemodialysis fistula maturation.


METHODS
Ninety-three fistulas were performed by a single surgeon from February 1, 2006 to January 31, 2009. Intraoperative vein dilatation with vessel probes was attempted in all fistulas. Measurements of the feeding artery diameter, vein diameter and the increased vein diameter after intraoperative dilatation were performed and immediate failure, early patency, early failure, primary patency, and fistula survival outcomes were recorded during 48-month follow-up.


RESULTS
Early failure occurred in 20% of fistulas and 70% matured sufficiently for cannulation. Variables with significant impact on the failure to mature by univariate analysis were: body-mass index (P=0.041), artery diameter (P<0.001), vein diameter (P=0.004), and vein diameter after dilatation (P=0.002). However, but multivariate analysis showed that only body-mass index (P=0.038), artery diameter (P=0.001), and the diameter of the vein after dilatation (P=0.018) significantly affected maturation. In a group of 56 (60%) patients with vein diameter before dilatation ≤ 2 mm, among vessel characteristics found by multivariate analysis, only vein diameter after dilatation (P=0.004) significantly affected function.


CONCLUSIONS
Artery diameter and vein diameter after intraoperative dilatation with vessel probes were the main predictors of fistula function.
Department of Surgery, General Hospital Bjelovar, Bjelovar, Croatia.
Branko
B
Fila
Department of Internal Medicine, General Hospital Bjelovar, Bjelovar, Croatia.
Vesna
V
Lovčić
Department for Medical Statistics, Epidemiology, and Medical Informatics, Andrija Stampar School of Public Health Medical Faculty University of Zagreb, Zagreb, Croatia.
Zdenko
Z
Sonicki
Department of Internal Medicine, General Hospital Bjelovar, Bjelovar, Croatia.
Saša
S
Magaš
Department of Surgery, General Hospital Bjelovar, Bjelovar, Croatia.
Zrinka
Z
Sudar-Magaš
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Marko
M
Malovrh
D001164:Arteriovenous Fistula / Q000601:surgery*; D001808:Blood Vessels / Q000033:anatomy & histology*; D004106:Dilatation; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D014654:Vascular Patency / Q000502:physiology