How does Arterio-Venous Fistula (AVF) influence the formation and change in Intime Media Thickness (IMT) in Hemodialysis Patients?
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Date
2025
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Publisher
Saudi Digital Library
Abstract
Background: Arteriovenous fistulas (AVFs) is an important vascular access for
hemodialysis patients. The impact of AVF creation on vascular remodeling mainly the intima
media thickness (IMT) of connected arteries and veins is still under investigation. This study
aims to evaluate the impact of a functioning or failed brachio-cephalic (BC) AVF on arterial
and venous IMT, as well as explore associations with fistula age and patient-related risk factors.
Methods: A cross-sectional observational study was conducted on 99 patients,
comprising 44 with functional AVFs, 15 with failed AVFs and 40 control patients with no AVFs.
Parameters collected from brachial artery and cephalic vein in this study are IMT, vessel
diameter (DIA), and arterial Peak systolic velocity (PSV) were measured using Doppler
ultrasound. Additionally demographic and the presence or absence clinical variables
hypertension (HTN), diabetes, high cholesterol, smoking and ischemic heart disease (IHD) were
recorded. Normality was assessed using the Shapiro-Wilk test, and appropriate statistical tests
(Kruskal-Wallis, Mann-Whitney U, Spearman’s and Pearson’s correlations) were applied.
Intraclass correlation coefficient (ICC) and Bland-Altman lot were used to assess Inter and
Intra- observer reliability.
Results: Both functional (mean ± SD, 0.676 ± 0.281 mm) and failed (0.859 ± 0.340 mm)
AVF had significantly larger brachial artery IMT compared to controls (0.393 ± 0.071 mm) (p <
0.001). Venous IMT was also significantly higher in the functional AVF group (0.450 ± 0.192
mm) compared with nonfunctional AVFs (0.324 ± 0.078 mm) and controls (0.153 ± 0.092 mm).
There were strong positive associations between fistula age and both arterial IMT (rs = 0.674, p
< 0.001) and venous IMT (rs=0.652, p<0.001). The risk factors analysis showed high prevalence
of hypertension and diabetes in patients with an AVF. Intra and inter observer reliability was
high ( ICC value>0.9) indicates excellent measurement reliability and reproducibility.
Conclusion: AVFs are associated with significant increases of arterial and venous IMT, larger
when fistulas failed. Vascular thickening is significantly correlated positively to fistula age,
indicative of gradual remodeling occurring in the long term. These results have important
implications for natural history of AVF follow-up and life-time vascular health in haemodialysis
subjects.
Description
This study investigates the impact of arteriovenous fistulas (AVFs) on vascular remodeling by evaluating intima-media thickness (IMT) in both the brachial artery and cephalic vein among haemodialysis patients. Using Doppler ultrasound, arterial and venous IMT, vessel diameter, and peak systolic velocity (PSV) were measured in three groups: functioning AVFs, failed AVFs, and controls without vascular access. The study also examines how IMT changes with fistula age and explores associations with common cardiovascular risk factors such as hypertension, diabetes, smoking, ischemic heart disease, and hypercholesterolemia. A combination of non-parametric statistical tests, correlation analyses, and reliability assessments (inter- and intra-observer) was performed to ensure robust evaluation of the vascular changes observed.
The findings demonstrate significantly increased IMT in both arteries and veins in patients with functioning and failed AVFs compared with controls, with strong positive correlations between fistula duration and IMT. These results highlight the progressive nature of vascular remodeling in AVFs and support the clinical value of IMT measurement as a potential marker for AVF maturation, dysfunction, and long-term patency. The study contributes meaningful insight to vascular ultrasound practice and underscores the importance of ongoing surveillance in haemodialysis access management.
Keywords
Artereovenous, fistula, renal failure, PSV, vascular, vascular ultrasound, kidney failure, IMT, Intima media thickness, statistics, fistula age, brachio-cephalic, arterial, venous