Decreased Upper Extremity Vein Diameter and Distensibility in Patients with Renal Failure

Objectives: Although DOQI guidelines promote the creation of autogenous arteriovenous fistulae (AVF), failure of AVFs to mature remains a significant clinical problem. The pre-operative identification of veins of sufficient size will promote increased utilization of AVFs and should prolong access patency. We investigated vein diameters and artery volume flow following warm water immersion in healthy controls and renal failure (RF) patients.
Methods: Utilizing duplex ultrasound, we measured the diameters of the cephalic and basilic veins at the wrist level, and brachial artery volume flow, at room temperature (24° C) and after warm water immersion (44° C) of the forearm for two minutes. A total of 50 arms were studied.
Results: Patients with RF had significantly decreased basilic and cephalic vein diameters (p = 0.001) in spite of similar brachial artery blood flows (Table).

Although vein diameters increased significantly with warming, vein size was still less in RF patients. There was a marked decrease in arterial reactivity in patients with RF as reflected by brachial artery flow.
Conclusion: As in healthy controls, the cephalic vein is larger than the basilic vein in patients with renal failure, confirming their preferential use for AVF. Patients with RF, however, have smaller veins at rest and decreased response to warming. This may help explain the lack of maturation of some radial-cephalic AVFs in patients with otherwise acceptable vein diameters.