title: The influence of cephalic vein diameter and diabetes on primary maturation and patency of autogenous radiocephalic arteriovenous fistulas.
abstract: OBJECTIVE
  This study identified predictors affecting maturation and patency of autogenous radiocephalic arteriovenous fistulas (RCAVFs).
  
  
  METHODS
  We retrospectively reviewed the prospectively collected clinical data of all patients who underwent primary RCAVF creation and evaluated the effect of clinical variables and findings of preoperative duplex ultrasound mapping on primary maturation and patency rates of RCAVFs.
  
  
  RESULTS
  From August 2008 to December 2010, 383 vascular access procedures were performed in 371 patients; of these, 331 (86.4%) were autogenous AVFs, 283 (85.5%) were primary first AVFs, and 186 (65.7%) of these were RCAVFs. The primary maturation rate was 88.2% at a mean of 39 ± 24.1 days after the operation. By multiple logistic regression analysis, minimum cephalic vein (CV) diameter >2 mm was an independent predictor of RCAVF maturation (odds ratio, 3.672; 95% confidence interval, 1.394-9.673; P = .008), which was more easily achieved in nondiabetic patients. During the mean follow-up of 47.2 ± 23.1 months, primary patency of RCAVFs was 80.3% at 1 year and 76.5% at 2 years. A Cox proportional hazard model showed diabetes was the only independent risk factor of primary patency (hazard ratio, 2.008; 95% confidence interval, 1.022-3.945; P = .043). Nondiabetic patients with a CV diameter >2 mm had significantly higher primary maturation rate and higher primary patency than diabetic patients with a CV diameter ≤2 mm.
  
  
  CONCLUSIONS
  There were different risk factors affecting RCAVF primary maturation and primary patency. A CV with a small-diameter of ≤2 mm combined with diabetes was an independent risk factor of failure not only of primary maturation but also of primary patency in RCAVF.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Yang Jin
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: ywkim@skku.edu.
authors.forename: Young-Wook
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Division of Transplantation Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Junhyuk David
authors.initials: JD
authors.lastname: Kwon
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong-Ik
authors.initials: DI
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hye-Ryeon
authors.initials: HR
authors.lastname: Jang
authors.affiliation: Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Heo
authors.affiliation: Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ha-Young
authors.initials: HY
authors.lastname: Oh
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014680:Veins / Q000033:anatomy & histology*