METHODS: From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia. Nine patients, with severe atherosclerosis of the distal artery, but with satisfactory veins, underwent forearm loop arteriovenous fistula creation. Maturation of the fistula was based on the classification by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI).

RESULTS: All nine patients who underwent forearm loop arteriovenous fistula have had diabetes mellitus for more than 10 years. Only one fistula failed to mature within 6 weeks. Two arteriovenous fistulas thrombosed at 3 and 5 months, respectively, after the commencement of haemodialysis. However, the other six matured fistulas are still functioning well after a year of regular usage.

METHOD: In total, 138 participants with stage IV and V chronic kidney disease were included in this prospective observational study. Preoperative vascular mapping using ultrasound was performed to evaluate the condition and size of the vessels to fulfil the inclusion criteria. Intraoperatively, the vessel size was measured prior to anastomosis under magnified view. A specimen from the arterial wall of 5 mm in diameter was obtained from the arterotomy for histopathology assessment. Arteriovenous maturation was assessed at 6 weeks with the guidance of the ultrasound criteria of rule of sixes.

RESULTS: From the total of 138 participants, 110 participants (79.7%) had matured arteriovenous fistula in 6 weeks. The mean size of the artery measured intraoperatively was 3.82 ± 1.33 mm and the vein was 4.05 ± 1.20 mm. Microcalcification in the arterial media which was hypothesised to be the cause of the arteriovenous fistula failure was insignificant, with a p value of 0.115. Despite having atherosclerosis in the artery, 83.3% of the arteriovenous fistula matured.