Study On Cubital Vein Dimensions of Patients Presenting for Dialysis Access Surgeries to A Single Unit in Sri Lanka: An Imaging-Based Study

Introduction: There are many patients with chronic kidney disease in need of renal replacement therapy (RRT) at present in Sri Lanka. Main mode of RRT is haemodialysis through an arteriovenous fistula (AVF). The diameter of the veins used for the AVF is important for its success. This study focuses on the dimensions of cubital veins.
Methodology: This is a prospective study done at the National Hospital of Sri Lanka Colombo (NHSL) from June to July 2020. Patients referred for AVFs were included. Data on patients’ age, gender, height, dominant hand, and diameters of the veins were collected. The diameters were measured at elbow crease using ultrasound scan.
Results: Sixty-seven patients were included with 34 (50.7%) females. Mean age was 44.63 years (interquartile range [IQR] 50.0-57.5). The mean diameters of the cephalic vein (CV) and the basilic vein (BV) were 3.57mm (IQR 2.6 - 4.25) and 3.36mm (IQR 4.0 - 3.98). The mean diameters of the median cubital vein (MC) and the median basilic vein (MB) were 4.95 mm (IQR 3.45 - 6.3) and 3.54 mm (IQR 2.7- 4.25). The MC diameter was significantly larger than CV and BV diameters (p=0. 0001). The mean diameter difference of CV and BV of patients less than or more than 158 cm height were not statistically significant (p=0.29 and 0.16).
Discussion: Guidelines recommend a vein diameter of 2.5 mm for a successful AVF creation. The best way to assess the diameter is the ultrasound imaging. This study shows that the diameter of the veins around the elbow varies. Therefore, imaging of the veins is essential prior to AVF creation.