Prediction of wrist arteriovenous fistula maturation with preoperative vein mapping with ultrasonography

Objective: The purpose of this study was to determine whether the preoperative, minimal cephalic vein size in the forearm was predictive of successful wrist fistula maturation to a functional hemodialysis access. Methods: Forty-four consecutive patients underwent evaluation before surgery with ultrasound scan imaging to map the entire cephalic vein in preparation for the construction of an arteriovenous fistula at the wrist. Measurements of the vein diameter were obtained from the ultrasound scan images at eight representative sites. Patients were clinically followed to determine maturation of the fistula to provide a functional hemodialysis access. The smallest diameter of the cephalic vein then was used as a preoperative predictor of fistula maturation. Results. Successful maturation of the arteriovenous fistula was achieved in 22 of the procedures (50%). Cephalic veins with a minimal diameter of 2.0 mm or less were used for anastamosis in 19 patients (43%), and three of these procedures (16%) led to a functional access site. The remaining 25 patients (57%) had minimal cephalic vein diameters greater than 2.0 mm, producing a successful maturation in 19 of the fistula creations (76%). A significantly higher rate of successful fistula maturation in those patients with a preoperative minimal cephalic vein size greater than 2.0 mm was realized (P = .0002, chi(2) test, with Yates correction for continuity). Conclusion: In patients with a minimal cephalic vein size of 2.0 mm or less, a procedure other than wrist fistula should be considered for optimization of dialysis access.