Introduction. Native arteriovenous fistula (AVF) is the recommended vascular access for HD patients by the Dialysis Outcomes Quality Initiative (DOQI) guidelines. The aim of our study was to determine the correlation between diameter and maturation of vessels in radiocephalic AVF. Methods. A prospective cross-sectional study carried out during 2006-2007 on 96 hemodialysis patients from Hasheminejad Kidney Center with non probability selection, all of them with end to side native AVF. Results. In this population 62.5% had wrist (distal radial artery) AVF and 37.5% had antecubital (proximal radial artery) AVF. The mean diameter of artery was 2.57？mm (SD = 1.09) and the mean diameter of vein was 2.40？mm (SD = 0.79). The mean of maturation period was 38.60 days (SD = 42.13). There were no relationship between duration of maturation period and diabetes mellitus, sex, age, diameter of vein and artery ( ). Period of maturation showed some correlation with the diameter of vein ( ) in patients with distal radiocephalic fistulae. Conclusions. The maturation of fistula shows correlation with vein diameter, but no correlation was seen with diameter of the arteries. There is much discrepancy between times to maturation in various reports. The average time for fistula maturation was 38/6 days in our study. 1. Introduction Surgery for hemodialysis (HD) access is the most commonly performed vascular surgical operation in the United States, predominantly because of a steady increase in the prevalence of end-stage renal disease (ESRD) [1]. Native arteriovenous fistula (AVF) is the recommended vascular access for HD patients by the Dialysis Outcomes Quality Initiative (DOQI) guidelines. The current national kidney foundation (DOQI) guidelines endorse this practice and recommend that initial cannulation be delayed for at least four weeks following surgery [2]. A fistula is considered mature when it can achieve a 300？mL/min dialysis blood flow within 1–6 months of its creation. Failure to mature (primary failure) is defined as the inability to meet this goal. Native AVF composed only 17% of all initial permanent hemodialysis access procedures performed in Medicare patients from 1996 to 1997 [3]. In 2002, the dialysis outcomes and practice patterns study (DOPPS) [2], one of the largest prospective observational studies published on hemodialysis practices and outcome in 309 international dialysis facilities, reported that AVF accounted for 24% of all access procedures in the United States, compared with 80% in Europe [4]. Gold standard for AVF maturation is the clinical
References
[1]
United States Renal Data System, “The economic cost of ESRD, vascular access procedure, and medicine spending for alternative modalities of treatment,” American Journal of Kidney Diseases, vol. 30, pp. S160–S770, 1997.
[2]
“NKF- K/ DOQI Clinical Practice Guidelines for Vascular Access: update 2000,” American Journal of Kidney Diseases, vol. 37, supplement 1, pp. 137–181, 2001.
[3]
“Use of hemodialysis access procedures,” in The Dartmouth Atlas of Vascular Health Care, J. L. Cronewett and J. D. Birkmeyer, Eds., p. 126, Health Forum, Chicago, Ill, USA, 2000.
[4]
R. L. Pisoni, E. W. Young, D. M. Dykstra et al., “Vascular access use in Europe and the United States: results from the DOPPS,” Kidney International, vol. 61, no. 1, pp. 305–316, 2002.
[5]
M. B. Silva Jr., R. W. Hobson, P. J. Rappas, et al., “A Strategy for increasing the use of Autogenous Hemodialysis Access Procedure: impact of perioperative non invasive evaluation,” Journal of Vascular Surgery, vol. 27, pp. 302–370, 1998.
[6]
R. R. Mendes, M. A. Farber, W. A. Marston, L. C. Dinwiddie, B. A. Keagy, and S. J. Burnham, “Prediction of wrist arteriovenous fistula maturation with preoperative vein mapping with ultrasonography,” Journal of Vascular Surgery, vol. 36, no. 3, pp. 460–463, 2002.
[7]
A. G. Hakaim, M. Nalbandian, and T. Scott, “Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes,” Journal of Vascular Surgery, vol. 27, no. 1, pp. 154–157, 1998.
[8]
T. E. Brothers, M. Morgan, J. G. Robison et al., “Failure of dialysis access: revise or replace?” Journal of Surgical Research, vol. 60, no. 2, pp. 312–316, 1996.
[9]
T. C. Hodges, M. F. Fillinger, R. M. Zwolak, D. B. Walsh, F. Bech, and J. L. Cronenwett, “Longitudinal comparison of dialysis access methods: risk factors for failure,” Journal of Vascular Surgery, vol. 26, no. 6, pp. 1009–1019, 1997.
[10]
P. E. Miller, A. Tolwani, C. P. Luscy et al., “Predictors of adequacy of arteriovenous fistulas in hemodialysis patients,” Kidney International, vol. 56, no. 1, pp. 275–280, 1999.
[11]
J. H. Tordoir, P. Rooyens, R. Dammers, et al., “Prespective evaluation of failure modes in autogenous radiocephalic wrist access for hemodialysis,” Nephrology Dialysis Transplantation, vol. 18, pp. 378–383, 2003.
[12]
H. Lee, B. Manns, K. Taub et al., “Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access,” American Journal of Kidney Diseases, vol. 40, no. 3, pp. 611–622, 2002.
[13]
D. A. Goodkin, D. L. Mapes, and P. J. Held, “The dialysis outcomes and Practice Patterns Study (DOPPS): how can we improve the care of hemodialysis patients?” Seminars in Dialysis, vol. 14, no. 3, pp. 157–159, 2001.
[14]
K. S. Brimble, C. G. Rabbat, D. J. Treleaven, and A. J. Ingram, “Utility of ultrasonographic venous assessment prior to forearm arteriovenous fistula creation,” Clinical Nephrology, vol. 58, no. 2, pp. 122–128, 2002.
[15]
V. Wong, R. Ward, J. Taylor, S. Selvakumar, T. V. How, and A. Bakran, “Factors associated with early failure of arteriovenous fistulae for haemodialysis access,” European Journal of Vascular and Endovascular Surgery, vol. 12, no. 2, pp. 207–213, 1996.
