Increased minimum vein diameter on preoperative mapping with duplex ultrasound is associated with arteriovenous fistula maturation and secondary patency

ObjectiveAutogenous arteriovenous hemodialysis accesses (arteriovenous fistulas [AVFs]) are preferred for chronic hemodialysis access. Preoperative vein mapping by duplex ultrasound is recommended before AVF creation, but there are few data correlating vein diameter with postoperative outcomes. Also, vein diameter has not been included in prior predictive models of fistula maturation. This study aims to test whether preoperative vein diameter is associated with failure of AVF maturation and long-term (secondary) patency.MethodsWe performed a retrospective analysis of clinical variables of patients undergoing brachiobasilic or brachiocephalic AVF creation. Kaplan-Meier and multivariate Cox regression models tested whether preoperative minimum vein diameter (MVD) and clinical covariates were associated with failure of AVF maturation and secondary patency.ResultsThe sample included 158 adults (54 ± 14 years; 45% male; 61% white; 56% diabetes; body mass index, 32 ± 8; MVD, 3.4 ± 1.1 mm; follow-up, 12 ± 9 months [range, <1-40 months]). Increased MVD was associated with decreased risk of AVF failure. More than one third of AVFs with MVD