Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients

Abstract

This study aims to evaluate the application of color Doppler ultrasound in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients.Patients with maintenance hemodialysis who underwent autologous arteriovenous fistula were enrolled in this cross-sectional study. Ultrasound was used to detect fistula complications (stenosis and thrombosis), brachial artery diameter, and hemodynamic parameters. The ultrasound parameters were analyzed and screened to identify the most important indicator for monitoring complications.In all, 89 patients were included. Ultrasound showed 72 cases (80.90%) had normal fistula structure, and 17 cases (19.10%) had complications. The diameter, time-averaged mean velocity, flow volume, and diastolic peak velocity of brachial artery in complication group were significantly lower than those of noncomplication group (P < .05). The brachial artery pulsatility index and resistance index of complication group were significantly higher than those of noncomplication group (P < .05). There was no significant difference in peak flow velocity between complication and noncomplication group (P > .05). Indicators showed statistical significance were grouped based on quantiles. The incidence of complications was higher when the brachial artery diameter was ≤5.40 mm, or brachial artery flow was ≤460 mL/ min, or brachial artery pulsatility index was >1.04, or brachial artery resistance index was >0.60.Ultrasound monitoring of brachial artery diameter and hemodynamic parameters can help early detection of fistula complications. When the brachial artery diameter was ≤5.40 mm, or brachial artery flow was ≤460 mL/min, or brachial artery pulsatility index was >1.04, or brachial artery resistance index >0.60, stenosis or thrombosis should be checked to prevent fistula failure.

Current State of Vascular Access in Patients on Hemodialysis in Bahrain

“…The Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline suggests that AVF should be used in at least 65% of patients on HD, while CVC should be used in less than 10% of patients. 6 Japan leads by example and reports having 1% on CVC. On the contrary CVC use in Belgium and Canada is 42%, and 44% respectively.…”

“…1,2,3 The most commonly used method of RRT is hemodialysis (HD), which requires well-functioning vascular access for its initiation and successful transition to dialysis. 4,5,6 Vascular access can be established by two main ways; native arteriovenous fistula (AVF) or arteriovenous graft (AVG), and central venous catheter (CVC). 6,7 Despite careful patient assessment, the smooth transition to dialysis and the creation of functional vascular access does not always result in permanent access availability because of numerous factors.…”

“…4,5,6 Vascular access can be established by two main ways; native arteriovenous fistula (AVF) or arteriovenous graft (AVG), and central venous catheter (CVC). 6,7 Despite careful patient assessment, the smooth transition to dialysis and the creation of functional vascular access does not always result in permanent access availability because of numerous factors. Maintaining functional vascular access remains a challenge for the vascular access team in dialysis units.…”

The diagnostic value of duplex ultrasound in detecting the presence and location of a stenosis in an autologous arteriovenous fistula

“…Systematic measurement of blood flow to monitor the development of a stenosis is also recommended by guidelines and other studies. 15,[21][22][23][24][25][26] It is associated with superior detection and elective treatment of stenosis, which leads to reduced thrombosis rates, improved fistula patency and lower costs.…”

Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis

“…Not only do the vein diameter and blood flow velocity increase significantly, but the flow properties also change from primarily steady state to pulsatile flow [28], under the influence of the arterial flow created at the anastomosis. This is demonstrated by markedly different systolic and diastolic blood flow velocities recorded from Doppler measurements on mature AVF [29]. Interestingly, the effects of AVF maturation are not consistent among patients and strongly dependent on patient-specific physiological parameters.…”