Relationship between intima-media thickness and arteriovenous fistula’s cannulation readiness

INTRODUCTION: Vascular access is necessary for patients with end-stage renal disease (ESRD) who require hemodialysis. The preferred vascular access for hemodialysis-dependent ESRD patients is arteriovenous fistula (AVF). Venous intima-media thickness (IMT) is defined as the sum of the echogenic thickness of the blood intima and hypoechoic media. Previous research regarding the relationship between IMT and cannulation readiness of AVF is not conclusive. This study aims to determine the relationship between IMT and the cannulation readiness of AVF. EVIDENCE ACQUISITION: Literature searching was conducted through several online databases, including Cochrane, PubMed, Clinical-Key, and manual searching. The articles published from 2010 to 2023 were included. Critical appraisal was conducted using a checklist from Joanna Briggs Institute. EVIDENCE SYNTHESIS: Database searching using specified key terms resulted in a total of 125 titles acquired. After duplicates were removed, a total of five titles that met the inclusion-exclusion criteria were acquired. Intima-media thickness, AVF maturation, and frequency of ultrasound were acquired in each study. CONCLUSIONS: Intima-media thickness influences cannulation readiness in patients with end-stage renal disease who undergo AVF. The modality that can be used to assess the thickness of the intima-media to predict cannulation readiness is duplex ultrasound (DUS). High-frequency DUS (40-55 MHz) can predict a vein thickness of 0.13 mm, whereas frequencies according to 7-12 MHz require an intima-media thickness of 0.26 mm to predict cannulation readiness. The thickness of intima-media between 0.13-0.26 is significantly associated with AVF maturity and cannulation readiness.