Abstract
BACKGROUND: Arteriovenous-fistula (AVF) are crucial for hemodialysis access, yet they frequently experience early failure. While studies have identified potential patient and clinical risk factors, these findings remain inconsistent. This inconsistency might be attributed to the varying definitions of "early failure". Our retrospective cohort study aimed to evaluate how common risk factors predict four frequently early-failure criteria: thrombosis/stenosis, <500 ml/min blood flow, <5 mm vein diameter, and ≥6 mm deep vein. We also assessed how well these risk factors predict early failure defined as meeting at least one of these criteria. Additionally, we examined the predictive ability of vein-distensibility, a previously overlooked factor in AVF failure. METHODS: Consecutive patients with first-time AVF employing standard minimum preoperative artery- and vein-diameters (1.8-2.0 mm) who underwent first Doppler-ultrasound (DUS) at ≤4 months in 2016-2022 were identified. Early AVF failure was defined as the presence of at least one of the following conditions on the first DUS: poor blood flow (Qa), poor vein diameter, poor vein depth, and thrombosis/stenosis. Factors associated with early AVF failure were explored with multivariate analyses. RESULTS: 105 patients were eligible and 63 (60%) had an early AVF failure. The only strong predictor of early failure was low vein-distensibility (Odds ratio = 0.57, 95% confidence intervals [CIs] = 0.38-0.83, p = 0.005). Female sex only predicted too-deep veins (Odds ratio = 14.29, 95% CIs = 2.00-100, p = 0.024). CONCLUSIONS: venous distensibility may be a useful early-failure determinant when minimum preoperative vessel-diameter limits are met. Moreover, the female sex is associated with too-deep AVF veins.