Presence of microcalcification in the arterial wall and its relationship to the maturation of the arteriovenous fistula in patients with chronic kidney disease stage 4 and 5
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Date
2018
Authors
Jun, Tang Weng
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
Introduction: A functioning and reliable arteriovenous fistula is a lifeline for individuals
suffering from chronic kidney disease who require regular haemodialysis treatment. The
success and failure to arteriovenous maturation have been frequently related to patient and
surgeon factors. The goal of this study is to evaluate the impact of pre-existing artery wall
abnormality on arteriovenous outcome. Specifically, to assess the association between the
formation of microcalcification in the intima-media of the arterial wall and arteriovenous
fistula maturation.
Method: 138 participants with stage IV and V chronic kidney disease were included in this
prospective observational study. Preoperative vascular mapping using an ultrasound was
performed by the operating surgeon to evaluate the condition and size of the vessels to fulfil
the inclusion criteria. Intraoperatively, the vessel size was measured again prior to anastomosis
under magnified view. A specimen from the arterial wall of 3-4 mm in diameter was obtained
from the arterotomy for histopathology assessment. Specimens were stained with Hematoxylin
and Eosin, Verhoeff’s Van Gieson and Von Kossa stains. A pathologist who was oblivious to
the patients′ clinical information, examined the specimen for microcalcification in the intimamedia
of the arterial wall and the media thickness. Arteriovenous maturation was assessed at 6
weeks, post-operatively, with the guidance of a duplex ultrasound.
Results: From the total of 138 participants, 110 participants (79.7%) had matured
arteriovenous fistula in 6 weeks. The mean size of the artery measured intraoperatively was
3.82 ± 1.33 mm and the vein was 4.05 ± 1.20 mm. Microcalcification in the arterial tunica
media which was hypothesised to be the cause of the arteriovenous fistula failure was
insignificant, with a P-value of 0.115. Despite having atherosclerosis in the artery, 83.3% of
the arteriovenous fistula matured.
Conclusion: Microcalcification and atherosclerosis are frequently seen in the arteries of
chronic kidney disease patients, but they do not explain arteriovenous fistula non-maturation.
Description
Keywords
Arteriovenous fistula