Skin Microcirculatory Changes in Relation to Arteriovenous Fistula Maturation

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Imaging

Background:

• Arteriovenous fistula (AVF) maturation is a complex vascular remodeling process.
• Monitoring microvascular changes is crucial for successful AVF creation and patient outcomes.

Purpose of the Study:

• To evaluate changes in skin microvascular perfusion during AVF maturation using laser Doppler fluximetry (LDF).
• To assess the relationship between perfusion changes and AVF maturation in patients with chronic kidney disease.

Main Methods:

• Laser Doppler fluximetry (LDF) was used to measure skin microvascular perfusion.
• Measurements were taken proximal and distal to the AVF anastomosis site at multiple time points (pre-op, day 1, week 2, week 6, week 12).
• 45 patients with Stages IV-V chronic kidney disease undergoing AVF creation were included.

Main Results:

• A 32.8% reduction in mean skin perfusion distal to the fistula was observed by day 1 post-operation.
• Perfusion distal to the fistula increased by 47% by week 2, with no significant subsequent changes.
• Proximal skin perfusion showed a non-statistically significant increase over 12 weeks.
• No significant correlation was found between perfusion changes and fistula type, diabetes, hypertension, or hyperlipidemia.

Conclusions:

• LDF effectively detected subclinical microvascular perfusion changes related to AVF creation.
• Early distal perfusion reduction after AVF creation may indicate a risk of ischemic symptoms in susceptible patients.
• Close monitoring for distal limb ischemia is recommended for patients with pre-existing perfusion inadequacy.