Abstract: Objective  To investigate the maturation and long-term patency of arteriovenous fistula (AVF) constructed by slender artery, and to analyze the influencing factors for maturation of the AVF based on the theory of vascular remodeling.   Method   Patients undergoing AVF operation using the radial artery diameter ≤1.5 mm for the construction were selected. The diameters of radial artery and cephalic vein were measured by ultrasound before operation; Blood flow and diameters of cephalic vein and brachial artery were measured after operation for one month. The maturation of AVF was evaluated and follow-up study was conducted for 12 months to analyze the prognosis of AVF established by slender vessels.  Result  Fifty-six patients were included in this study. Before operation, the mean diameter of radial artery was 1.26±0.28 mm, and the smallest diameter of radial artery was 0.5 mm; the average diameter of the cephalic vein after dilatation by tourniquet was 2.72±0.53 mm. AFV maturation progressed naturally without intervention in 40 patients (71.43%), and the AVF maturated after endovascular surgery or surgical reconstruction in 13 (23.21%) of the remaining 16 patients. Regression model showed that radial artery diameter was an independent factor for predicting AVF maturation, and the best critical value for predicting AVF maturation was radial artery diameter ＞1.35 mm. The average follow-up time of the 56 patients was 11.39±5.81 months. After the operation for 3, 6 and 12 months, the primary patency rates were 73.08%, 68.75% and 65.71% respectively and the secondary patency rates were 100%, 97.92% and 100% respectively.  Conclusions  AVF constructed by slender radial artery has a high maturity rate and long-term patency rate. The radial artery diameter over 1.35mm is more likely to mature naturally.

Key words: Vascular access, Arteriovenous fistula, Slender artery, Vascular remodeling, Maturation of arteriovenous fistula