Brachial artery and cephalic vein diameter as maturation predictors of brachiocephalic arteriovenous fistula in end-stage renal diseases with type 2 diabetes mellitus

Dedy Pratama; Ahmad Daenuri; Aria Kekalih; Patrianef Darwis; Muhammad Farel Ferian; Bany Faris Amin

doi:10.15562/bmj.v11i3.3573

Brachial artery and cephalic vein diameter as maturation predictors of brachiocephalic arteriovenous fistula in end-stage renal diseases with type 2 diabetes mellitus

Dedy Pratama ,

Ahmad Daenuri ,

Aria Kekalih ,

Patrianef Darwis ,

Muhammad Farel Ferian ,

Bany Faris Amin ,

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DOI: https://doi.org/10.15562/bmj.v11i3.3573 |
Published: 2022-10-04

Abstract

Introduction: Arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis in end-stage renal disease (ESRD) patients. There is a high rate of AVF maturation failure, especially in DM patients, and it takes longer for maturation in diabetes mellitus (DM) patients. This study aimed to obtain the recommendations for the minimum diameter of the brachial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in ESRD patients with type 2 diabetes mellitus after six weeks to eight weeks of AVF creation.

Methods: This study is a retrospective cohort study using secondary data from patients with brachiocephalic arteriovenous fistula. The examined variables were brachial artery diameter, cephalic vein diameter, and brachiocephalic arteriovenous fistula maturation. Comparative analysis and ROC curve analysis were performed.

Results: A total of 72 patients met the inclusion and exclusion criteria. Forty-four (61,11%) patients were mature at six weeks, while 47 (65,28%) were mature at eight weeks postoperatively. At week six, the mature group had a significantly larger cephalic vein diameter (3,20±0,94 vs. 2,65±1,02, p=0,002). At week eight there was a significantly larger brachial artery (4,22±0,70 vs 3,78±0,60, p=0,012), and cephalic vein diameter (3,28±0,98 vs 2,43±0,82, p=0,000) in the mature group.

Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation eighth week was 3.85 mm. The best threshold value for preoperative cephalic vein diameter predicting AVF maturation at the sixth week was 2.45 mm, and at the eighth week, it was 2.45 mm.

References

Mardhatillah M, Arsin A, Syafar M, Hardianti A. Ketahanan hidup pasien penyakit ginjal kronik yang menjalani hemodialisis di RSUP DR. Wahidin Sudirohusodo Makassar. J Kesehat Masy Marit. 2020;3(1).
11th report of Indonesian renal registry. Jakarta: PERNEFRI; 2018. 1–46 p.
Beigi AA, Sadeghi AMM, Khosravi AR, Karami M, Masoudpour H. Effects of the arteriovenous fistula on pulmonary artery pressure and cardiac output in patients with chronic renal failure. J Vasc Access. 2009 Sep;10(3):160–6.
Brahmbhatt A, Remuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney Int. 2016 Feb;89(2):303–16.
Yan Y, Ye D, Yang L, Ye W, Zhan D, Zhang L, et al. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Ren Fail. 2018 Nov;40(1):379–83.
Dageforde LA, Harms KA, Feurer ID, Shaffer D. Increased minimum vein diameter on preoperative mapping with duplex ultrasound is associated with arteriovenous fistula maturation and secondary patency. J Vasc Surg. 2015 Jan;61(1):170–6.
Lauvao LS, Ihnat DM, Goshima KR, Chavez L, Gruessner AC, Mills JL. Vein diameter is the major predictor of fistula maturation. J Vasc Surg. 2009 Jun;49(6):1499–504.
Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg. 2008 Nov;48(5 Suppl):2S-25S.
Zhang F, Li Y, Wang T, Tao J, Zhu J, Wei M, et al. Influence of cephalic vein dilation on arteriovenous fistula maturation in patients with small cephalic veins. Medicine (Baltimore). 2020 Jan 3;99(1):e18576.
Lee HS, Park MJ, Yoon SY, Joo N, Song YR, Kim HJ, et al. Role of peribrachial fat as a key determinant of brachial artery dilatation for successful arteriovenous fistula maturation in hemodialysis patients. Sci Rep. 2020 Mar 2;10(1):3841.
Vernaglione L, Mele G, Cristofano C, Distratis C, Perrone F, Frascina M, et al. Comorbid conditions and gender impact the primary survival of distal radio-cephalic arteriovenous fistula inpatients on long-term hemodialysis. J Nephrol. 2005 Jun;18(3):276–81.
Feldman HI, Joffe M, Rosas SE, Burns JE, Knauss J, Brayman K. Predictors of successful arteriovenous fistula maturation. Am J Kidney Dis Off J Natl Kidney Found. 2003 Nov;42(5):1000–12.
Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg. 2007 Feb;45(2):420–6.
Kim YO, Choi YJ, Kim JI, Kim YS, Kim BS, Park CW, et al. The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. J Korean Med Sci. 2006 Apr;21(2):284–9.
Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005 Jun;67(6):2462–9.
Taddei S, Virdis A, Ghiadoni L, Salvetti G, Salvetti A. Endothelial dysfunction in hypertension. J Nephrol. 2000 Jun;13(3):205–10.
Satoh M. Endothelial dysfunction as an underlying pathophysiological condition of chronic kidney disease. Clin Exp Nephrol. 2012 Aug;16(4):518–21.
Kim JT, Chang WH, Oh TY, Jeong YK. Venous distensibility as a key factor in the success of arteriovenous fistulas at the wrist. Ann Vasc Surg. 2011 Nov;25(8):1094–8.
Ferring M, Claridge M, Smith SA, Wilmink T. Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: a randomized trial. Clin J Am Soc Nephrol CJASN. 2010 Dec;5(12):2236–44.
Maya ID, O'Neal JC, Young CJ, Barker-Finkel J, Allon M. Outcomes of Brachiocephalic Fistulas, Transposed Brachiobasilic Fistulas, and Upper Arm Grafts. Clin J Am Soc Nephrol CJASN. 2009 Jan;4(1):86–92.