Can preoperative parameters and histopathology of the vessels affect arteriovenous fistula outcomes? A prospective observational study

doi:10.5527/wjn.v15.i2.118363

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World Journal of Nephrology

ISSN

2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Jun 25, 2026; 15(2): 118363
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118363

Can preoperative parameters and histopathology of the vessels affect arteriovenous fistula outcomes? A prospective observational study

Prashanth Adiga K, Shreyas N Michael, Suyog Shetty, Abheesh Varma Hegde, Sajal Gupta

Sajal Gupta, Abheesh Varma Hegde, Suyog Shetty, Shreyas N Michael, Prashanth Adiga K, Department of Urology and Renal Transplantation, Father Muller Medical College, Mangalore 575002, Karnātaka, India

Author contributions: Gupta S contributed to concept, collection of data, preparing table and figures; Gupta S, Hegde AV, and Shetty S contributed to write the manuscript; Hegde AV, Shetty S, Michael SN, and Adiga K P contributed to supervision. All authors have read and approved the final manuscript.

Institutional review board statement: This study was conducted at a single tertiary care hospital in India after approval was obtained from the Institutional Ethics Committee (approval No. FMIEC/CCM/428/2024).

Clinical trial registration statement: Not applicable.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: Not applicable.

Data sharing statement: Data will be shared when needed or asked.

Corresponding author: Sajal Gupta, MBBS, MS, MCH Urology Resident, Academic Fellow, Principal Investigator, Department of Urology and Renal Transplantation, Father Muller Medical College, Kankanady, Mangalore 575002, Karnātaka, India. sajal.dare@gmail.com

Received: December 30, 2025
Revised: January 24, 2026
Accepted: March 17, 2026
Published online: June 25, 2026
Processing time: 167 Days and 12 Hours

Abstract

BACKGROUND

Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis in patients with chronic kidney disease; however, early failure remains common.

AIM

To determine clinical, biochemical, Doppler ultrasound and histopathological predictors of early AVF outcomes.

METHODS

In this single-center prospective observational study, 69 adult patients undergoing AVF creation were evaluated preoperatively using clinical assessment, laboratory investigations (lipid profile and serum calcium), and Doppler ultrasonography. Intraoperative edge biopsies of the artery and vein were obtained for histopathological analysis. Patients were followed at 1, 6, and 12 weeks postoperatively. Associations between preoperative and histological factors and AVF patency, maturation, and early complications were assessed using univariate and multivariate analyses.

RESULTS

The mean patient age was 51.6 ± 11.6 years, and 82.6% were men. Age > 60 years [odds ratio (OR): 5.25], alcohol use (OR: 13.75), and low high-density lipoprotein cholesterol (OR: 0.167) were independently associated with surgical site infection. Early postoperative bleeding was associated with elevated triglyceride levels, abnormal vessel morphology, smaller arterial diameter, and greater vessel depth. AVF maturation was adversely associated with smoking (OR: 2.76), elevated triglycerides (OR: 0.144), abnormal vessel wall histology (OR: 1.58), and suboptimal vascular characteristics.

CONCLUSION

Smaller and deeper vessels identified on preoperative Doppler ultrasonography, dyslipidemia, and histological vessel wall abnormalities were independently associated with poorer AVF outcomes. Routine lipid screening and selective use of intraoperative vessel wall biopsy may assist in identifying patients at higher risk of AVF failure and inform vascular access planning in chronic kidney disease.

Keywords: Arteriovenous fistula; Hemodialysis; Chronic kidney disease; Doppler ultrasonography; Vascular histopathology; Dyslipidemia

Core Tip: A prospective observational study is done to show preoperative parameters and histopathology of the vessels can also tell the outcome of arteriovenous fistula. This study will increase the horizon of readers of the journal to think in this direction, and will help to prognosticate end-stage renal disease patients post arteriovenous fistula.