The Relation between Radial Artery, Cephalic Vein Diameter and Early Obstruction of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients

Jung, Yeong Ho; Kim, Nam Il; Kim, Young Ok; Yoon, Sun Ae; Moon, In Sung; Park, Jang Sang; Yoo, Seung Jin; Kim, Seung Nam; Koh, Yong Bok

Abstract

Early obstruction of arteriovenous fistula (AVF) is one of the most frequent problems associated with vascular access in patients with chronic renal failure undergoing hemodialysis. It is concluded that old age and diabetes mellitus are risk factors for obstruction of AVF in hemodialysis patients. In order to evaluate the relation between radial artery, cephalic vein diameter and early obstruction of radiocephalic AVF within 3 months after operation, we measured radial artery, cephalic vein diameter and anastomosis length under the microscope during operation in 67 patients undergoing radiocephalic arteriovenous fistula. The mean age of patients was 50 13 (25~74) years old and male to female ratio was 0.8. Diabetic nephropathy was most common underlying renal disease. The incidence of early obstruction of AVF within 3 months after operation was 14.9% (10 patients). Radial artery diameter of successful group was statistically larger than that of failed group (2.77+/-0.70 mm vs 2.08+/-0.35 mm, p<0.001). But there was no difference in cephalic vein diameter (1.93+/-0.70 mm vs 1.64 0.40 mm, p=0.199) and in anastomosis length (1.66+/-0.23 cm vs 1.67+/-0.17 cm, p=0.913) between two groups. There was no statistical difference in age, sex, overweight, time of puncture after operation, blood pressure between successful and failed group. The incidence of diabetes mellitus of failed group tended to be higher than that of successful group, but there was no statistical difference between two groups (60.0% vs 40.3%, p=0.247). There was no statistical difference in all laboratory findings including hemoglobin, hematocrit, platelet, serum albumin, and total cholesterol between two groups. In conclusion, radial artery diameter was associated with the early obstruction of radiocephalic AVF, while cephalic vein was unrelated to early obstruction. If radial artery is small in patients undergoing radiocephalic AVF, AVF at elbow or synthetic graft should be considered.