Calcification in Abdominal Aorta and Vascular Access: Exploring Association with Failure of Arterio-Venous Fistula in Hemodialysis Patients

Background: Arteriovenous fistulas are the preferred vascular access for hemodialysis. However, their failure remains a significant challenge. Several factors contribute to their failure including vascular calcifications, which is one among them. The present study aimed to analyse the role of Abdominal aortic calcification and Vascular access calcification in predicting poor fistula maturation and patency. Methods: This was a prospective observational study of 200 patients with CKD (stages 4 and 5) who underwent fistula surgery between August 2022 and August 2023, with preoperative radiological assessment by lateral abdominal radiography for Abdominal aortic calcification, upper limb radiography for Vascular access calcification, and upper limb Doppler for vessels, and 146 patients were followed up for 1 year. The association between vascular calcification and fistula failure was analysed. Results: Abdominal aortic and Vascular access calcifications were observed in 29% and 19% of the study population, respectively. The observed primary failure rate (within 3 months) was 24.5% and the secondary failure rate (at 1 year) was 15.7%. High-grade calcification of the abdominal aorta and vascular access were associated with significantly higher fistula failure rates, with primary failure rates of 84.6% and 54.1%, and secondary failure rates of nearly 100% and 66.6%, respectively. Logistic regression analysis revealed that Abdominal aortic calcification and Vascular access calcification independently predicted primary and secondary fistula failures. Conclusion: Abdominal aortic calcification and Vascular access calcification are associated with poor maturation and increased failure rates of Arteriovenous fistulas. This emphasizes the significance of proper preoperative assessment of vessels, which helps in patient selection for fistula and thus potentially improves outcomes.