Ultrasound-derived Hemodynamic Parameters for Predicting Presence and Site of Arteriovenous Fistula Stenosis

To investigate predictive performance of ultrasound-derived hemodynamic parameters in detecting ≥50% stenosis in patients with hemodialysis arteriovenous fistula (AVF), as well as to determine predictors of juxta-anastomotic stenosis (JAS).

This single-center retrospective study reviewed patients with AVFs who underwent both ultrasound and fistulogram. Basic demographics, comorbidities, AVF configuration, stenosis type, image time interval, US hemodynamic parameters, and angiographic information were compared.

A total of 87 patients were included. Both the stenotic peak systolic velocity (PSV) and Δstenotic-to-juxtastenotic PSV (adjusted odds ratio [aOR] = 1.282; 95% confidence interval, 1.103-1.491; p = 0.001) are associated with ≥50% stenosis, with the latter demonstrating superior predictive value (area under the curve [AUC], 0.659 vs. 0.799; p = 0.004). Restricted cubic spline (RCS) analysis showed that a larger Δstenotic-to-juxtastenotic PSV had an increased risk of ≥50% stenosis (p = 0.012). Furthermore, anastomotic PSV (aOR = 1.003; 95% CI, 1.001-1.006; p = 0.002) distinguished JAS from stenosis in draining or outflow vein. Among JAS patients, the Δstenotic-to-juxtastenotic PSV was slightly superior to Δanastomotic PSV in detecting ≥50% stenosis.

Ultrasound-derived hemodynamic parameters based on PSV may serve as useful predictors in detecting the presence and site of AVF stenosis. Δstenotic-to-juxtastenotic PSV demonstrated superior diagnostic performance for detecting overall AVF stenosis and JAS. A larger Δstenotic-to-juxtastenotic PSV was associated with an increased risk of ≥50% stenosis. Anastomotic PSV may help distinguish effective in distinguishing JAS from stenosis located in draining or outflow vein.