Annals of vascular surgery · 2026
Exploration of the Influence of Cephalic Vein Fibrosis on the Maturation of Arteriovenous Fistula in Type 2 Diabetes Patients.
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Zhao Bin, Fu Gang, Zhan Shen, Guo Shanshan, Wang Yuzhu
Аннотация
BACKGROUND: The objective of this study was to investigate the association between cephalic vein fibrosis and the maturation of arteriovenous fistulas (AVF) in hemodialysis patients with type 2 diabetes (T2D).
METHODS: A total of 67 patients with end-stage renal disease (ESRD) undergoing AVF creation were divided into diabetic and nondiabetic cohorts. Individuals with type 1 diabetes were excluded from the study. The cephalic vein tissues were collected and detected using Masson's staining. Logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was utilized to evaluate predictive value.
RESULTS: The maturation rate was 45.2% in diabetic group (n = 31) and 69.4% in nondiabetic group (n = 36). Preoperative venous diameter did not significantly differ between groups (P > 0.05). The C-reactive protein (CRP) (t = -2.209, P = 0.043) and the collagen volume fraction (CVF)% (t = -5.295, P < 0.001) in the T2D group were significantly elevated compared to the non-T2D group, whereas the internal diameter of cephalic vein at 1-month postoperation and parathyroid hormone (PTH) (t = 2.412, P = 0.019) in the T2D group were significantly reduced relative to the non-T2D group. Logistic regression analysis across multiple models revealed that T2D, CVF%, and the internal diameter of cephalic vein at 1-month postoperation were independent determinants of AVF maturation. Additionally, histopathological analysis demonstrated that the CVF% (t = -5.067, P < 0.001) was significantly higher in the T2D group compared to the non-T2D group.
CONCLUSION: The findings indicated that T2D, reduced postoperative venous diameter, and increased cephalic vein fibrosis (CVF%) were significant independent risk factors affecting AVF maturation. Although preoperative venous diameter is a known clinical predictor, it was not an independent factor in our models after adjusting for fibrosis and diabetes status. Diabetes might impair AVF maturation primarily by exacerbating preoperative cephalic vein fibrosis, which likely restricts venous outward remodeling and expansion after fistula creation.
METHODS: A total of 67 patients with end-stage renal disease (ESRD) undergoing AVF creation were divided into diabetic and nondiabetic cohorts. Individuals with type 1 diabetes were excluded from the study. The cephalic vein tissues were collected and detected using Masson's staining. Logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was utilized to evaluate predictive value.
RESULTS: The maturation rate was 45.2% in diabetic group (n = 31) and 69.4% in nondiabetic group (n = 36). Preoperative venous diameter did not significantly differ between groups (P > 0.05). The C-reactive protein (CRP) (t = -2.209, P = 0.043) and the collagen volume fraction (CVF)% (t = -5.295, P < 0.001) in the T2D group were significantly elevated compared to the non-T2D group, whereas the internal diameter of cephalic vein at 1-month postoperation and parathyroid hormone (PTH) (t = 2.412, P = 0.019) in the T2D group were significantly reduced relative to the non-T2D group. Logistic regression analysis across multiple models revealed that T2D, CVF%, and the internal diameter of cephalic vein at 1-month postoperation were independent determinants of AVF maturation. Additionally, histopathological analysis demonstrated that the CVF% (t = -5.067, P < 0.001) was significantly higher in the T2D group compared to the non-T2D group.
CONCLUSION: The findings indicated that T2D, reduced postoperative venous diameter, and increased cephalic vein fibrosis (CVF%) were significant independent risk factors affecting AVF maturation. Although preoperative venous diameter is a known clinical predictor, it was not an independent factor in our models after adjusting for fibrosis and diabetes status. Diabetes might impair AVF maturation primarily by exacerbating preoperative cephalic vein fibrosis, which likely restricts venous outward remodeling and expansion after fistula creation.