Vessel diameter and radiocephalic arteriovenous fistula: A meta-analysis and Markov model

The aim of this study was to determine the optimal radial artery (RA) and cephalic vein (CV) diameter for the best functional maturation (FM) of radiocephalic arteriovenous fistula with their financial implication.

A systematic review and meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines included 4610 patients. The data was initially subjected to Pearson correlation to evaluate success-to-failure ratios on the endpoint of FM, to rule out the impact of confounders. This allowed for the meta-analysis using a random-effects model, assessing odds ratios (ORs) at 95% confidence intervals (CIs) relative to the line of no effect. Outcomes were subjected to Markov chain model, incorporating transition probabilities and sequential decision-making. Post-hoc analysis was performed to assess the adequacy of the sample size. This review is registered with International Prospective Register for Systematic Review (PROSPERO): CRD42022348509.

There was a moderate negative correlation (r = -0.44; P > .05), indicating no significant linear relationship. A CV diameter of 2 to 2.4 mm was associated with the best FM (OR, 1.29; 95% CI, 1.01-1.65; P < .04), whereas an RA diameter of 2 mm achieved an OR of 1.27 (95% CI, 0.95-1.7). The cost per arteriovenous fistula creation was £3079 for CV-based and £4285 for RA-diameter based approach. The CV diameter of 2 to 2.4 mm was the most cost-effective at £2411. Post-hoc power analysis confirmed the adequacy of the sample size with an effect size of d = 0.547 for an objective inference.

Superior maturation is plausible with a CV diameter of 2 to 2.4 mm and a RA diameter of 2 mm or more. Diameters below these thresholds yield poorer outcomes, whereas larger diameters provide no additional benefit.