Feasibility analysis of small-caliber arteriovenous fistula for establishing vascular access in dialysis-dependent patients.

INTRODUCTION

Autogenous arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Small-caliber vessels (arterial diameter <1.5 mm or venous diameter <2.0 mm), are known risk factors for AVF maturation failure. This study investigated the minimum vessel threshold suitable for AVF creation and evaluated its long-term effectiveness.

METHODS

This multi-center prospective study included 140 patients with end-stage kidney disease aged ⩾18 years with ejection fraction ⩾30% (mean age 54.64 ± 13.79 years; 66.4% male). Patients were divided into small-caliber (n = 72) or normal (n = 68) groups. Logistic regression evaluated risk factors for AVF maturation and Kaplan-Meier analysis assessed functional survival.

RESULTS

Small-caliber vessels were significantly associated with failure of functional maturation (OR = 0.256, 95% CI [0.06-0.75], p = 0.033). Functional maturity improved when vein diameter exceeded 1.35 mm and/or artery diameter exceeded 1.25 mm (p < 0.01).

CONCLUSION

With careful preoperative Doppler ultrasound assessment, refined surgical technique, and close postoperative monitoring, satisfactory AVF maturation can be achieved.