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Related Experiment Videos

Native arteriovenous fistula: preoperative evaluation.

Marko Malovrh1

  • 1Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia. marko.malovrh@mf.uni-lj.si

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|June 5, 2002
PubMed
Summary

Duplex sonography accurately predicts arteriovenous fistula (AVF) success by measuring vessel size and blood flow before surgery. These noninvasive assessments help determine optimal AVF construction sites and maturation times, improving outcomes for patients with end-stage renal disease.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Diagnostic Imaging

Background:

  • Arteriovenous fistula (AVF) creation is crucial for hemodialysis access in end-stage renal disease (ESRD) patients.
  • Predicting AVF patency and maturation remains a challenge, impacting treatment efficacy and patient outcomes.
  • Duplex sonography offers a noninvasive method to evaluate vascular parameters relevant to AVF success.

Purpose of the Study:

  • To prospectively identify prognostic indicators of native AVF patency and maturation using duplex sonography.
  • To correlate preoperative and postoperative sonographic measurements with AVF outcomes.
  • To guide optimal AVF construction and timing for improved patient selection and management.

Main Methods:

  • Prospective study involving 116 ESRD patients undergoing native AVF construction.

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  • Preoperative duplex sonography measured feeding artery internal diameter (IDA), resistance index (RI) at reactive hyperemia (RH), arterial blood flow (Q(A)), and vein internal diameter (IDV) with proximal vein compression (PVC).
  • Postoperative measurements were repeated at various intervals to assess changes and correlate with AVF patency.

    • Main Results:

    • Overall primary patency rate was 80.2%. Failed AVFs showed smaller IDA, higher RI at RH, and lower Q(A) compared to successful AVFs.
    • Preoperative IDA > 0.16 cm and RI at RH < 0.7 were significantly associated with higher patency rates (93% and 95.3%, respectively).
    • Sonographic parameters predicted time to adequate AVF flow (Q(A) of 300 mL/min), aiding in determining optimal maturation time.

    Conclusions:

    • Duplex sonography provides valuable preoperative data on vessel morphology and function for predicting AVF primary patency.
    • Increases in IDA, Q(A), RI at RH, and IDV after PVC are key indicators of successful AVF development.
    • Sonographic assessment enables informed decisions on AVF site selection and maturation timing, especially for high-risk patients.