Can preoperative parameters and histopathology of the vessels affect arteriovenous fistula outcomes? A prospective observational study

BACKGROUND: Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis in patients with chronic kidney disease; however, early failure remains common. AIM: To determine clinical, biochemical, Doppler ultrasound and histopathological predictors of early AVF outcomes. METHODS: In this single-center prospective observational study, 69 adult patients undergoing AVF creation were evaluated preoperatively using clinical assessment, laboratory investigations (lipid profile and serum calcium), and Doppler ultrasonography. Intraoperative edge biopsies of the artery and vein were obtained for histopathological analysis. Patients were followed at 1, 6, and 12 weeks postoperatively. Associations between preoperative and histological factors and AVF patency, maturation, and early complications were assessed using univariate and multivariate analyses. RESULTS: The mean patient age was 51.6 ± 11.6 years, and 82.6% were men. Age > 60 years [odds ratio (OR): 5.25], alcohol use (OR: 13.75), and low high-density lipoprotein cholesterol (OR: 0.167) were independently associated with surgical site infection. Early postoperative bleeding was associated with elevated triglyceride levels, abnormal vessel morphology, smaller arterial diameter, and greater vessel depth. AVF maturation was adversely associated with smoking (OR: 2.76), elevated triglycerides (OR: 0.144), abnormal vessel wall histology (OR: 1.58), and suboptimal vascular characteristics. CONCLUSION: Smaller and deeper vessels identified on preoperative Doppler ultrasonography, dyslipidemia, and histological vessel wall abnormalities were independently associated with poorer AVF outcomes. Routine lipid screening and selective use of intraoperative vessel wall biopsy may assist in identifying patients at higher risk of AVF failure and inform vascular access planning in chronic kidney disease.