JENG-WEI CHENTing, MaoMaoTingChang, Po-YaPo-YaChangJung, Chiau-JingChiau-JingJungChang, Chin-HaoChin-HaoChangFang, Shi-YuShi-YuFangLiu, Li-WeiLi-WeiLiuYang, Kelvin JeasonKelvin JeasonYangYu, Sz-HanSz-HanYuYIH-SHARNG CHENNAI-HSIN CHIRON-BIN HSUCHIH-HSIEN WANGI-HUI WUHSI-YU YUCHIH-YANG CHAN2024-11-202024-11-202025-0109296646https://scholars.lib.ntu.edu.tw/handle/123456789/723162Background: 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.entrueArteriovenous fistulaComputer-assisted image interpretationHistological techniqueVascular smooth muscle[SDGs]SDG2[SDGs]SDG3journal article10.1016/j.jfma.2024.03.004384929852-s2.0-85187979508