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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Publication statusE-pub ahead of print - Mar 15 2024


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