Cephalic Vein Distensibility as a Predictor of Arteriovenous Fistula Maturation

Background: A significant limitation of arteriovenous fistulas is their high primary failure rate due to nonmaturation. Dilation of the vein is an important feature, which occurs as a response to increased blood flow and consequent shear stress after creation of a fistula. We studied the influence of cephalic vein distensibility on fistula maturation. Materials and Methods: A prospective study was carried out with 40 patients undergoing radiocephalic fistula. The diameter of the distended cephalic vein was measured 3 min after occluding the vein using a tourniquet, by duplex ultrasound examination. The cases were followed up for 6 weeks to assess the maturation of the fistula and its relationship with distensibility. Results: Majority of the patients were men (55%), with hypertension being the major comorbidity. The fistula maturation rate was 65%. There was a significant difference in distensibility ( P = 0.003), distensibility ratio ( P = 0.017), vein diameter at 2 weeks ( P < 0.001), diameter at 6 weeks ( P < 0.001), and flow rate ( P < 0.001) between the maturation and nonmaturation groups. Conclusions: Cephalic vein diameter cannot be considered an independent predictor for arteriovenous fistula (AVF) maturation. The degree of distensibility of the cephalic vein is an important determinant of radiocephalic AVF maturation success.