AUTHOR=Feng Ruijia , Wang Siwen , Chang Guangqi , Zhang Wayne W. , Liu Qinghua , Wang Xin , Chen Wei , Wang Shenming 

TITLE=The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1070084

DOI=10.3389/fcvm.2023.1070084

ISSN=2297-055X

ABSTRACT=Objective: Autogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation. 
Design: Single-center retrospective study. 
Method: Patients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on receiver operating curve (ROC) and Youden index. Kaplan-Meier analysis was utilized in further patency rate comparisons.  
Result: A total of 125 forearm AVFs were created in 121 end-stage renal disease (ESRD) patients. The mean age was 53.88±15.10 years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17±0.54 mm and 1.71±0.75 mm respectively. Small caliber vein is the risk factor for functional maturation failure (OR=0.256, 95%CI [0.06-0.75], P=0.033) and additional intervention (OR=0.306, 95% CI [0.09-0.78], P=0.031). The optimal cutoff is 1.35 mm (augmented), when specificity and sensitivity reach 80% and 63.7% respectively. The AVFs with vein diameter more than 1.35 mm (augmented) showed higher patency rates (P<0.01). 
Conclusion: After comprehensive DUS evaluation, intraoperative hydrodilation, post-operative active exercise and intensive DUS detection, and application of balloon assisted maturation if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.