| Objective The aim of this study was to assess the correlation between preoperative cephalic venous intiamal hyperplasia and clinical characteristics and the primary patency rate of radiaocephalic arteriovenous fistula(RCAVF)in the wrist,and to explore the risk factors affecting the life of the arteriovenous fistula(AVF).As a results,it can provide a basis for further improving the primary patency rate of RCAVF and prolonging the life of arteriovenous fistula.Methods A total of 165 patients with the first operation of RCAVF performed from July 2016 to November 2019 were retrospectively enrolled in this study at the Hemodialysis Center of Baotou Clinical Medical College,Inner Mongolia Medical University.Retrospectively collected preoperative vascular ultrasonography indexes and basic data.Preoperative vascular ultrasonography indicators include the internal diameter of the cephalic vein,the internal diameter of the radial artery,peak systolic velocity(PSV),resistance index(RI),and arterial calcification or atherosclerosis.Basic information includes:age,gender,primary renal disease,haemoglobin(HB),calcium(Ca),blood inorganic phosphorus(P),parathyroid hormone(PTH),and C-reaction Protein(CRP).During this study,cephalic vein tissues from patients with first-time RCAVF were already collected and embedded with paraffin.Followig paraffin embedding,each cephalic vein specimen was cut into 4um and prepared for Masson’s trichrome staining.AVF outcomes were determined by querying the electronic medical record system or dialysis records.Kapan-Meier method was used to draw the survival curve.Based on the results of morphological analysis,the correlation between pathological changes such as intimal hyperplasia and other factors included was related to AVF outcomes.The statistically significant indicators of univariate analysis were included in the binary logistic regression analysis to identify the risk factors that affect the primary patency rate of RCAVF.According to the screened risk factors,the diagnostic criteria of continuous variables were formulated by drawing receiver operator characteristic(ROC).The area under the curve,sensitivity,and specificity were used to evaluate the curve.The positive predictive value,negative predictive value and accuracy rate were used to evaluate the diagnostic value of the screened index,and the optimal diagnostic index was selected.P value<0.05 was considered statistically significant.Results This study finally included 165 patients who underwent first-time wrist RCAVF,including 135 in the RCAVF patency group and 30 in the failure group.The Kapan-Meier survival curve showed that the primary patency rate of RCAVF in this study population at 12 months was 81%,at 24 months was 79%,and both 36 and 48months was 76%.Univariate analysis of pathological changes such as intimal hyperplasia,medial thickening,lumen stenosis,and other factors included with AVF outcomes showed that the proportion of patients with non-diabetic nephropathy in the AVF patency group was high(χ~2=15.311,P=0.000),The preoperative radial artery calcification rate was low(χ~2=4.418,P=0.036),the internal diameter of the cephalic vein was larger(t=-2.661,P=0.009),and the radial artery RI was lower(t=2.182,P=0.031);there was no statistical difference between the two groups in other indicators(P>0.05).This study analyzed the correlation between the basic data and the condition of preoperative cephalic venous intimal hyperplasia.The results showed that age was a risk factor for preoperative cephalic venous intimal hyperplasia(t=3.294,P=0.001).Significant results from the univariate analysis were included in the binary logistic regression analysis.The results showed that diabetes(OR=0.26,95%CI:0.09～0.70,P=0.008)and internal diameter of the cephalic vein(OR=0.29,95%CI:0.12～0.73,P=0.009)are two independent risk factors for predicting RCAVF patency.ROC curve analysis showed that the area under the curve of the cephalic vein diameter was 0.659,and the optimal threshold was 2.005 mm.Conclusion The data of this study shows that the preoperative cephalic vein internal diameter and diabetes are two predictors for RCAVF primary patency.However,the morphological parameters of cephalic vein tissue such as intimal hyperplasia,medial thickening and lumen stenosis before operation may have nothing to do with the primary patency rate of RCAVF in the wrist. |
