Comprehensive Evaluation of Hemodialysis Arteriovenous Fistula Dysfunction Using 2D-Ultrasound, Elastography, and...

To evaluate the diagnostic value of multimodal ultrasound-including 2D-ultrasound, sound touch elastography (STE), and vector flow imaging (VFI)-for the identification of functional and biomechanical abnormalities indicative of arteriovenous fistula (AVF) stenosis or occlusion in hemodialysis patients.

This prospective study enrolled 37 hemodialysis patients with AVFs, divided into normal (n = 20) and dysfunction (n = 17) groups based on digital subtraction angiography (DSA) or clinical/ultrasound criteria. For the dysfunction group, AVF stenosis was defined as >50% luminal diameter reduction on DSA, and occlusion as complete absence of flow. For the normal group, dysfunction was excluded by clinical examination (thrill/bruit) and normal duplex parameters. All patients underwent 2D-ultrasound, STE, and VFI examinations. Key parameters measured included vessel diameter, elasticity (kPa), blood flow velocities, turbulence index, and wall shear stress (WSS). Statistical comparisons were made between groups.

No significant differences were found in vessel diameter or intima status between groups. However, the stenosis/occlusion group exhibited significantly lower mean blood flow, peak systolic/end-diastolic velocities, and WSS, along with higher resistance index and vessel wall stiffness (STE-mean: 30.35 ± 11.65 vs. 20.7 ± 7.52 kPa, p < 0.01). VFI revealed reduced blood flow velocity, turbulence, and WSS in dysfunctional AVFs (all p < 0.01).

Multimodal ultrasound integrating 2D-ultrasound, STE, and VFI provides a comprehensive assessment of AVF structure and function, detecting functional and biomechanical abnormalities associated with AVF stenosis or occlusion.