Venous Distensibility as a Key Factor in the Success of Arteriovenous Fistulas at the Wrist

Background The diameter of veins in the superficial forearm has been shown to correlate with risk for nonmaturation of newly created arteriovenous fistulas (AVFs). However, reported cut-off diameters are inconsistent. The purpose of our study was to assess the optimal diameter and distensibility of the radiocephalic vein at the wrist using the tourniquet method. Methods We selected 50 consecutive patients who received AVFs between June 2007 and July 2009. All patients underwent venography before surgery. Approximately 30 minutes after the first venography, the upper arm cuff was inflated to stop superficial venous return. After 1 minute, a second venography was performed, after which the diameters of the distended radiocephalic veins were measured. We used these data to determine the optimal size and distensibility of the radiocephalic vein for a successful AVF at the wrist. Results Participants consisted of 38 men and 12 women. We found no significant correlation between diabetes or hypertension and success of AVFs. We found that radiocephalic veins with diameters >3.25 mm after the tourniquet maneuver had a fourfold higher success rate compared with that of smaller veins, but this difference was not statistically significant ( p = 0.09). We also found that the procedure success rate was significantly higher with radiocephalic veins whose diameters increased by >0.35 mm during venography (odds ratio = 7.422). Conclusion For AVFs, it is important to use radiocephalic veins with a diameter of ≥3.25 mm after the tourniquet maneuver. In addition, AVF outcomes at the wrist are significantly better using radiocephalic veins that show an increase of >0.35 mm on venography.