Promjer vene nakon intraoperativne dilatacije kao pretkazatelj uspjeha krvožilnoga pristupa za hemodijalizu [Vein diameter after intraoperative dilatation as a predictor of success of hemodialysis arteriovenous fistulas]

Introduction: Vascular access is “the life line” for patients on chronic hemodialysis. The autogenous arteriovenous fistula provides the best access to the circulation because of low complication rate, long-term use, and lower cost, compared to arteriovenous graft and central venous catheter. Vessel characteristics are the most important factors affecting success in angioaccess surgery. Vein diameter after intraoperative dilatation is a new predictor and has never been investigated. Objectives: The primary objective of this prospective study was to investigate the predictive value of vein diameter after intraoperative dilatation with vessel probes on hemodialysis fistula maturation. Methods: From February 1, 2006 to January 31, 2009 ninety-three fistulas were investigated. Following characteristics were included in statistical analysis: age, gender, body-mass index, diabetes, hypertension, central venous catether, first fistula construction, location of access, vein diameter, artery diameter and vein diameter after intraoperative dilatation. Results: Early failure occurred in 20 % of fistulas and 70 % matured sufficiently for cannulation. Variables with significant impact on the failure to mature by univariate analysis were: body-mass index (P = 0,041), artery diameter (P < 0,001), vein diameter (P = 0,004), and vein diameter after dilatation (P = 0,002). However, multivariate analysis showed that only body-mass index (P = 0,038), artery diameter (P = 0.001), and the diameter of the vein after dilatation (P = 0,018) significantly affected maturation. In a group of patients with vein diameter before dilatation ≤2 mm, among vessel characteristics found by multivariate analysis, only vein diameter after dilatation (P = 0,004) significantly affected function. Conclusion: Vein diameter after intraoperative dilatation with vessel probes and artery diameter were the main predictors of fistula function.