[Parameters predicting arterious-venous fistula maturation in pre surgery vascular mapping]

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Imaging

Background:

• Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis.
• Pre-surgical evaluation is crucial for successful AVF creation and predicting outcomes.
• Echo-color Doppler offers valuable morphological and functional data for vascular access planning.

Purpose of the Study:

• To identify pre-operative echo-color Doppler parameters that predict AVF maturation.
• To assess the utility of Doppler ultrasound in optimizing AVF creation for hemodialysis patients.

Main Methods:

• 44 patients undergoing AVF creation were evaluated pre-surgery using echo-color Doppler.
• Pre-surgery measurements included vessel caliber, flow, and resistive index (RI) of the radial and brachial arteries, along with a reactive hyperemia test.
• Post-surgery evaluation at 30 days assessed AVF flow and cephalic vein caliber.

Main Results:

• A direct correlation was found between AVF flow and pre-surgery cephalic vein/radial artery caliber, brachial artery caliber, and RI reduction post-hyperemia.
• Statistically significant differences were observed between groups with adequate AVF maturation and those with early failure or failure to mature.
• Receiver Operating Characteristic (ROC) curves identified specific thresholds for RI change (Δ RI = 0.15) and flow (Δ flow = 150 ml/m) as predictors of AVF outcome.

Conclusions:

• Pre-surgery echo-color Doppler parameters, including vessel caliber and hemodynamic indices, can predict AVF maturation success.
• These findings aid in selecting appropriate vessels and anticipating AVF outcomes, potentially improving hemodialysis access.
• Echo-color Doppler is a valuable tool for pre-operative assessment to optimize AVF creation for hemodialysis.