Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation

Jeng-Wei Chen; Mao Ting; Po-Ya Chang; Chiau-Jing Jung; Chin-Hao Chang; Shi-Yu Fang; Li-Wei Liu; Kelvin Jeason Yang; Sz-Han Yu; Yih-Sharng Chen; Nai-Hsin Chi; Ron-Bin Hsu; Chih-Hsien Wang; I-Hui Wu; Hsi-Yu Yu; Chih-Yang Chan

doi:10.1016/j.jfma.2024.03.004

Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation

J Formos Med Assoc. 2024 Mar 15:S0929-6646(24)00149-9. doi: 10.1016/j.jfma.2024.03.004. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
³ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: chanchihyang@ntuh.org.tw.

PMID: 38492985
DOI: 10.1016/j.jfma.2024.03.004

Abstract

Background: We used computer-assisted image analysis to determine whether preexisting histological features of the cephalic vein influence the risk of non-maturation of wrist fistulas.

Methods: This study focused on patients aged 20-80 years who underwent their first wrist fistula creation. A total of 206 patients participated, and vein samples for Masson's trichrome staining were collected from 134 patients. From these, 94 patients provided a complete girth of the venous specimen for automatic image analysis. Maturation was assessed using ultrasound within 90 days after surgery.

Results: The collagen to muscle ratio in the target vein, measured by computer-assisted imaging, was a strong predictor of non-maturation in wrist fistulas. Receiver operating characteristic analysis revealed an area under the curve of 0.864 (95% confidence interval of 0.782-0.946, p < 0.001). The optimal cut-off value for the ratio was 1.138, as determined by the Youden index maximum method, with a sensitivity of 89.0% and specificity of 71.4%. For easy application, we used a cutoff value of 1.0; the non-maturation rates for patients with ratios >1 and ≤ 1 were 51.7% (15 out of 29 patients) and 9.2% (6 out of 65 patients), respectively. Chi-square testing revealed significantly different non-maturation rates between the two groups (X² (1, N = 94) = 20.9, p < 0.01).

Conclusion: Computer-assisted image interpretation can help to quantify the preexisting histological patterns of the cephalic vein, while the collagen-to-muscle ratio can predict non-maturation of wrist fistula development at an early stage.

Keywords: Arteriovenous fistula; Computer-assisted image interpretation; Histological technique; Vascular smooth muscle.