Objective: To determine the optimal radial artery (RA) and cephalic vein (CV) diameter for the best functional maturation (FM) of Radiocephalic Arteriovenous Fistula (RCAVF) with their financial implication.
Methods: A systematic review and meta-analysis following PRISMA guidelines included n =4,610 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.
Results: There was a moderate negative correlation (r=-0.44) p>0.05 indicating no significant linear relationship. A CV diameter of 2-2.4 mm was associated with the best FM (OR: 1.29, 95% CI: 1.01-1.65, p<0.04), while an RA diameter of 2 mm achieved an OR of 1.27 (95% CI: 0.95-1.7). The cost per AVF creation was £3079 for CV-based and £4285 for RA-diameter based approach. The CV diameter of 2-2.4 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.
Conclusion: Superior maturation is plausible with a CV diameter of 2-2.4 mm and a RA diameter of 2 mm or more. Diameters below these thresholds yield poorer outcomes, while larger diameters provide no additional benefit.
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