Background
The incidence of end-stage renal disease is progressively increasing, with more than a fifth of cases progressing to dialysis yearly. According to the newest The Kidney Disease Outcome Quality Initiative (KDOQI) and The National Kidney Foundation (NFK), they consider autologous arteriovenous fistulas (AVFs) as a primary method of choice in hemodialysis patients. To this date, different studies have evaluated the impact of several different variables on the primary functional maturation (FM) of AVFs. One of the preoperative investigations used is ultrasound mapping on vessels. Even so, the vessels meet the minimal threshold diameter for surgical AVF creation, but still, there is high rate of AVF maturation failure. This suggests a need to reassess the preoperative ultrasound criteria used to optimize AVF maturation.
Aim
The aim of this study is to demonstrate that the suggested measurement technique of arteriovenous ratio (AVR) index obtained from inflow (arterial diameter) to that of outflow (venous diameter) is an independent predictor of primary FM of AVFs. This study implies that minimal diameter difference between inflow and outflow remains crucial for optimal hemodynamics of AVFs irrespective of other variables.
Patients and methods
This a prospective observational cohort study that was conducted at Ain Shams University hospitals on 120 patients presented with end-stage renal failure between November 2020 and March 2022, which were submitted for AVF.
Results
This study shows that the AVR index has significant importance in FM of AVF. As shown, AVR index of 1.01–1.06 and 1.06–1.14 has maturation rate of 100%. While as the AVR index increases or decreases away from AVR index subgroups of 1.01–1.06 and 1.06–1.14, the rate of FM decreases subsequently reaching to only 57.9% in AVR index 0–0.79 and 55.6% in AVR index 1.51–2.63.
Conclusion
The outcome of this study demonstrates that the suggested novel measurement technique (AVR index) is an independent predictor of FM in AVFs. This study implies that minimal diameter (i.e. inflow artery diameter to outflow cephalic vein diameter) mismatch, irrespective of other variables, remains crucial for optimal hemodynamics of AVFs and their primary FM.