Role of Doppler Ultrasound in the Evaluation of Arteriovenous Fistula Maturation and Detection of Complications in Hemodialysis Patients

TL;DR

Doppler ultrasound helps track the development and complications of blood vessel connections used for kidney dialysis, improving patient outcomes.

Contribution

This study demonstrates that Doppler ultrasound parameters predict arteriovenous fistula maturation and failure in hemodialysis patients.

Findings

Doppler ultrasound parameters like preoperative vessel diameters and four-week flow rates predict AVF maturation and primary failure.

Fistula flow rates increased significantly from day 1 to four weeks postoperatively.

Primary failure was associated with diabetes, hypertension, smaller preoperative vessel diameters, and lower four-week flow rates.

Abstract

Objective: This study aimed to assess the utility of Doppler ultrasound (DUS) in the preoperative planning, intraoperative guidance, and postoperative monitoring of arteriovenous fistulas (AVFs) for hemodialysis, focusing on vascular mapping, maturation assessment, and early complication detection.

Methodology: This prospective study included 109 patients undergoing AVF creation for hemodialysis access. Preoperative DUS was performed to assess the cephalic vein's and radial artery's diameters and flow parameters. Postoperative evaluations were conducted on days 1 and 7 and at four weeks to monitor vein diameter, flow rates, and complications. Patients were followed until successful cannulation or the determination of primary failure.

Results: Of the 109 patients, 63 (57.8%) were male, with a mean age of 52.4 years. Diabetes was present in 59 (54.1%) patients and hypertension in 57 (52.3%). The mean preoperative cephalic vein diameter was 1.98 ± 0.58 mm, increasing to 9.07 ± 0.75 mm at four weeks postoperatively. Fistula flow rates improved from 261.1 ± 106.3 mL/min on day 1 to 689.7 ± 138.09 mL/min at four weeks. By week 4, 56 (51.4%) AVFs had achieved adequate maturation. Primary failure occurred in 27 (24.8%) patients and was significantly associated with diabetes, hypertension, smaller preoperative vessel diameters, and lower four-week flow rates (p < 0.001). The mean time to maturation was 38.03 ± 6.8 days, and the mean time to first successful cannulation was 50.4 ± 8.1 days.

Conclusion: DUS parameters, particularly preoperative vessel diameters and four-week flow rates, significantly predict AVF maturation and primary failure. Routine ultrasound evaluation facilitates optimal vascular access planning, the early detection of complications, and improved AVF outcomes in hemodialysis patients.