Abstract: Objective  To evaluate the regulatory effects of perivascular adipose tissue (PVAT) volume around autologous arteriovenous fistulas (AVF) and fat attenuation index (FAI) on vascular remodeling in patients with AVF.  Methods  A total of 90 patients undergoing AVF surgery in the three clinical trial centers were enrolled in this study. Fat volume and FAI around the AVF in the area of vessel length equal to the vessel diameter (d) were measured by CT at the second postoperative day. AVF patency after the surgery for one year was assessed by Doppler ultrasound. The patients were then divided into non-adverse event group and adverse event group according to the Chinese Expert Consensus on Vascular Access for Hemodialysis, 2nd edition. Multivariate logistic regression model was used to analyze the impacts of PVAT volume and FAI on AVF patency in one year after surgery.  Results  Patients in adverse event group (n=21) had less PVAT volume (t=6.572, P=0.018) and higher FAI (t=-4.883, P=0.025) as compared with those in non-adverse event group (n=61). Logistic regression showed that fat volume (OR=0.256, 95% CI:0.087～0.752, P=0.013) and FAI (OR=1.064, 95% CI:1.007～1.124, P=0.026) were the independent predictive factors for AVF adverse events.  Conclusion  PVAT volume was the protective factors and FAI was the risk factor for AVF patency. Patients with high risk of AVF adverse events can be identified by early postoperative screening, so as to decrease the negative factors and improve the prognosis of AVF.

Key words: Hemodialysis, Perivascular adipose tissue, Arteriovenous fistula, Fat volume, Fat attenuation index