Impact of Intraoperative Cephalic Vein Dilatation on Short Term Outcomes of Radiocephalic Arteriovenous Fistula – a prospective comparative study

Purpose: Radiocephalic arteriovenous fistula (AVF) is the initial and most frequently created access for hemodialysis in patients with kidney failure. This study evaluated the impact of intraoperative dilatation of the cephalic vein on the short-term radiological and clinical outcomes of radiocephalic AVF in patients with kidney failure. Methods: After applying the inclusion criteria, 91 patients who underwent RC-AVF surgery were included and divided into two groups: those who underwent intraoperative cephalic vein dilatation (46 patients) and those who did not (45 patients). Intraoperative venous dilatation was performed by pushing saline into the cephalic vein through a cannula and using pressure from assistant’s finger proximally. Vein diameter and AVF flow rates were evaluated radiologically using Doppler ultrasonography at 6 weeks and fistula maturation by HFM criteria was assessed at 10-12 weeks postoperatively. Results: The fistula maturation rate was 84.61% (77 out of 91); 93.47% (43 out of 46) in dilatation group compared to 75.55% (34 out of 45) in non-dilatation group (p = 0.017). Doppler ultrasonography revealed significantly higher increase in post-operative vein diameters (p = 0.0197) and AVF flow rates (p = 0.0026) in the dilatation group compared to the non-dilation group. Complication rates, including infection and hematoma, were comparable between both groups. Conclusion: Intraoperative cephalic vein dilatation during radiocephalic fistula surgery in kidney failure patients is associated with improved AVF maturation rates. This novel technique may help in technical feasibility of radiocephalic AVF surgery with improvement in short term AV fistula success for initiation of hemodialysis.