A prospective study of factors associated with successful maturation of arteriovenous fistulas for hemodialysis.

AIM

Our objective was to determine the factors associated with the successful maturation of arteriovenous fistulas during hemodialysis.

MATERIAL AND METHODS

This prospective study included patients treated with hemodialysis and predialysis patients. Clinical, biochemical, sociodemographic, vascular ultrasound mapping, flow-mediated dilatation, and surgical factors were analyzed. Success in the maturation process was defined by ultrasonographic criteria at six weeks.

RESULTS

Thirty-seven patients were included. With a mean ± standard deviation age of 40 ± 14 years, 73% were male, 65% had type-2 diabetes mellitus, and 95% had hypertension. Arteriovenous fistulas were brachycephalic in 18 patients (49%), brachymedian in nine patients (24%), brachycommunicating posterior in five patients (14%), brachibasal in three patients (8%), radiocephalic in two patients (8%), and radiocephalic in two patients (5%). Fourteen percent of patients had unsuccessful maturation. The vein diameter was 4.3 ± 1.0 mm (maturation group) vs 3.2 ± 0.9 mm (non-maturation group), = 0.04. The artery diameter was similar: 4.5 ± 0.6 vs 4.5 ± 0.4, = 0.88. Logistic regression analysis revealed that the diameter of the vein for which the surgery was performed was the factor associated with successful maturation in our population, odds ratio = 4.77 (1.14-19.97), -value = 0.032.

CONCLUSIONS

It is highly important to plan vascular access in patients to perform vascular mapping and measure veins and arteries in patients. Vein measurement is a significant factor in successful maturation of the arteriovenous fistulas.