High-resolution ultrasound showing increased intima and media thickness of the radial artery in patients with end-stage renal disease

Objective: Although clinically relevant atherosclerosis of the upper limb arteries is rarely seen, intimal hyperplasia of the arteries may reflect global atherosclerosis and increased intima-media thickness of the brachial artery has been linked to an increased risk of cardiovascular events and to early failure of the radiocephalic arteriovenous fistula. We speculated that patients with ESRD have thickening of both the radial intimal and medial layers compared to healthy subjects. Methods: Ultrasound biomicroscopy is a novel very high frequency (55 MHz) ultrasound technique that could accurately measure the intima and media thickness of the vessel wall. No previous study has measured intima and media thickness separately in patients with end-stage renal disease and hence, the aim of the current study was to investigate the radial arterial wall layers in patients with chronic renal failure. Results: Thirty-one patients with end-stage renal disease and 41 healthy subjects underwent ultrasound biomicroscopy of the radial arteries. Blood pressures did not differ except for pulse pressures which were elevated among patients with end-stage renal disease (p < 0.01). Patients with end-stage renal disease showed 39% thicker intima and 18% greater media in the radial artery compared to healthy subjects (0.117±0.031mm versus 0.084±0.02mm for the IT, p < 0.01 and 0.205±0.062mm versus 0.174±0.044mm for the MT; p < 0.05). Conclusions: Both the intima and the media layers of the radial arteries are increased in patients with endstage renal disease. Whether measurements of the radial arterial intima thickness may convey valuable information on the risk of future cardiovascular events and early arteriovenous fistula failure in end-stage renal disease remain to be elucidated in future studies.