PURPOSE: To compare various objective ultrasonographic (US) criteria for native arteriovenous fistula (AVF) maturation with subsequent fistula outcomes and clinical evaluation by experienced dialysis nurses.
MATERIALS AND METHODS: US fistula evaluation results were analyzed retrospectively in 69 patients within 4 months after AVF placement; adequacy for dialysis was known in 54. Measurements included minimum venous diameter and blood flow rate. Experienced dialysis nurses examined 30 fistulas clinically. Predictors of fistula adequacy were analyzed with univariate and multivariate logistic regression. Mean fistula diameters and blood flow rates were compared by using analysis of variance or unpaired Student t tests.
RESULTS: Fistula adequacy for dialysis doubled if the minimum venous diameter was 0.4 cm or greater (89% [24 of 27]) versus less than 0.4 cm (44% [12 of 27]; P < .001). Fistula adequacy for dialysis was nearly doubled if flow volume was 500 mL/min or greater (84% [26 of 31]) versus less than 500 mL/min (43% [nine of 21]; P = .002). Combining venous diameter and flow volume increased fistula adequacy predictive value: minimum venous diameter of 0.4 cm or greater and flow volume of 500 mL/min or greater (95% [19 of 20]) versus neither criterion met (33% [five of 15]; P = .002). Women were less likely to have an adequate fistula diameter of 0.4 cm or greater: 40% (12 of 30) of women versus 69% (27 of 39; P = .015) of men. No significant differences in blood flow or minimum venous diameter were found during 2–4 postoperative months. Experienced dialysis nurses’ accuracy in predicting eventual fistula maturity was 80% (24 of 30).
CONCLUSION: US measurements of AVF at 2–4 months in patients undergoing hemodialysis are highly predictive of fistula maturation and adequacy for dialysis.
© RSNA, 2002
- 1 National Kidney Foundation-Dialysis Outcome Quality Initiative. NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis 1997; 30(4 suppl 3):S150-S191. Medline, Google Scholar
- 2 Palder SB, Kirkman RL, Whittemore AD, Hakim RM, Lazarus M, Tilney NL. Vascular access for hemodialysis: patency rates and results of revision. Ann Surg 1985; 202:235-239. Crossref, Medline, Google Scholar
- 3 Miller PE, Tolwani A, Luscy CP, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999; 56:275-280. Crossref, Medline, Google Scholar
- 4 Allon M, Lockhart ME, Lilly RZ, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001; 60:2013-2020. Crossref, Medline, Google Scholar
- 5 Won T, Jang JW, Lee S, Han JJ, Park YS, Ahn JH. Effects of intraoperative blood flow on the early patency of radiocephalic fistulas. Ann Vasc Surg 2000; 14:468-472. Crossref, Medline, Google Scholar
- 6 Robbin ML, Oser RF, Allon M, Clements M, Dockery JS, Weber TM. Hemodialysis access graft stenosis: US detection. Radiology 1998; 208:655-661. Link, Google Scholar
- 7 Lockhart ME, Robbin ML. Hemodialysis access ultrasound. Ultrasound Q 2001; 17:157-167. Crossref, Medline, Google Scholar
- 8 Robbin ML, Gallichio MH, Deierhoi MH, Young CJ, Weber TM, Allon M. US vascular mapping before hemodialysis access placement. Radiology 2000; 217:83-88. Link, Google Scholar
- 9 Churchill DN, Taylor DW, Cook RJ, et al. Canadian Hemodialysis Morbidity Study. Am J Kidney Dis 1992; 19:214-234. Crossref, Medline, Google Scholar
- 10 Health Care Financing Administration. Other vascular access findings for October–December 1999. 2000 Annual Report: ESRD Clinical Performance Measures Project 2000; 27-30. Google Scholar
- 11 Beathard GA. Strategy for maximizing the use of arteriovenous fistulae. Semin Dial 2000; 13:291-296. Crossref, Medline, Google Scholar
- 12 Tanriover B, Carlton D, Saddekni S, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int 2000; 57:2151-2155. Crossref, Medline, Google Scholar
- 13 Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 1999; 33:910-916. Crossref, Medline, Google Scholar
- 14 Beathard GA. Physical examination of the dialysis vascular access. Semin Dial 1998; 11:231-236. Crossref, Google Scholar
- 15 Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996; 12:207-213. Crossref, Medline, Google Scholar
- 16 Hirth RA, Turenne MN, Woods JD, et al. Predictors of type of vascular access in hemodialysis patients. JAMA 1996; 276:1303-1307. Crossref, Medline, Google Scholar
- 17 Kinnaert P, Vereerstraeten P, Toussaint C, Van Geertruyden J. Nine years’ experience with internal arteriovenous fistulas for haemodialysis: a study of some factors influencing the results. Br J Surg 1977; 64:242-246. Crossref, Medline, Google Scholar
- 18 Bay WH, Henry ML, Lazarus JM, Lew NL, Ling J, Lowrie EG. Predicting hemodialysis access failure with color flow Doppler ultrasound. Am J Nephrol 1998; 18:296-304. Crossref, Medline, Google Scholar
- 19 Lin SL, Huang CH, Chen HS, Hsu WA, Yen CJ, Yen TS. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol 1998; 18:96-100. Crossref, Medline, Google Scholar