Role of preoperative duplex ultrasonography to predict functional maturation of wrist radiocephalic arteriovenous fistula: A study on indian population

• Published in: Indian journal of nephrology Vol. 28; no. 1; pp. 10 - 14
• Main Authors: Srivastava, A, Sureka, S, Prabhakaran, S, Lal, H, Ansari, M, Kapoor, R
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Age; Arteriovenous fistula; Calcification; Care and treatment; Chronic kidney failure; Diabetes; Diagnosis; Fistula; Hemodialysis; Original; Surgery; Transplants & implants; Ultrasonic imaging; Ultrasound imaging; Urology; Variables; Veins & arteries; India; Arteriovenous fistula; hemodialysis access; duplex ultrasonography; maturation of arteriovenous fistula
• ISSN: 0971-4065; 1998-3662
• DOI: 10.4103/ijn.IJN_134_16

Radiocephalic arteriovenous fistula (RCAVF) is the first choice for native arteriovenous fistula (AVF). Preoperative vessel assessment with ultrasonography (USG) has been reported to enhance the outcome of native AVF, but data regarding its predictive value for functional maturation of RCAVF are scanty. We aimed to determine the role of preoperative duplex USG (DUS) for prediction of functional maturity of radiocephalic fistula in the wrist. The data from 173 patients were analyzed prospectively. The estimated duplex variable included size, patency, and continuity of cephalic vein and size, peak systolic velocity, and wall calcifications in radial artery at the wrist. The subjects underwent RCAVF creation and were reviewed 6-8 weeks post procedure for adequacy of maturation. Doppler variables between successful and failed maturation groups were compared. Successful functional fistula maturation was noted in 138 (80.9%) patients. Values of radial artery diameter, cephalic vein diameter, and peak systolic velocity were >2 mm, 2.2 mm, and 32.8 cm/s, respectively, for successful maturation of RCAVF in more than 90% of cases. Vascular calcifications were detected preoperatively in 15 diabetic patients and 9 (60%) of them had fistula failure. Preoperative DUS can provide a good prediction on functional maturation of RCAVF. Vascular calcifications were associated with high risk of maturation failure in diabetics.