Duplex Ultrasound for the Prediction of Vascular Events Associated with Arteriovenous Fistulas in Hemodialysis Patients

Ishii, Takeo; Suzuki, Yasunobu; Nakayama, Takuji; Ohmori, Miki; Masai, Shinichi; Sasagawa, N; Ohyama, Kunio

doi:10.5301/jva.5000595

Cited by 29 publications

(24 citation statements)

References 26 publications

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“…However, the RIs of the arteries had similar changing trends, inferring that the RI is not a sensitive marker for identifying the function of AVFs. This result was different from those of other studies, which suggested that the RI cut-off was 0.56 for fistula intervention 20 or 0.63 for early fistula failure. 18 The differences in the enrolled patients, AVF failure definitions, and observed endpoints might be attributed to these varying results.…”

Section: Discussioncontrasting

confidence: 99%

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Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Zhang

Wan

et al. 2019

J Vasc Access

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Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = −3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = −2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

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Section: Discussioncontrasting

confidence: 99%

“…The earliest time points to predict the outcome of AVFs changed from 1 day to 12 weeks after surgery. 12,14,18–20,24,25…”

Section: Discussionmentioning

confidence: 99%

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Zhang

Wan

et al. 2019

J Vasc Access

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“…Thrombosis can be prevented by having a closer look at stenosis. An active screening strategy by systematic Doppler or Transonic ® flow rates could reduce the risk of thrombotic events of VA [27,28]. European and international guidelines recommend regular and objective monitoring of access function (ideally every month for AVG and every 3 months for AVF) [29].…”

Section: Discussionmentioning

confidence: 99%

Mean Platelet Volume Predicts Vascular Access Events in Hemodialysis Patients

Lano

Sallée

Pelletier

et al. 2019

JCM

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Arteriovenous fistula (AVF) and arteriovenous graft (AVG) is the vascular access (VA) of 78% of hemodialysis patients (HD) in France. VA dysfunction corresponding to either stenosis requiring angioplasty or acute thrombosis is responsible for 30% of hospitalizations. Mean platelet volume (MPV) is a biological marker of cardiovascular events. We studied MPV in a cohort of HD patients as a predictive marker of VA dysfunction. We conducted a prospective monocentric cohort study that included patients with AVF or AVG on chronic HD (n = 153). The primary outcome was the incidence of VA dysfunction regarding MPV value. The median MPV was 10.8 fL (7.8–13.5), and four groups were designed according to MPV quartiles. Fifty-four patients experienced the first event of VA dysfunction. The incidence of VA dysfunction was higher in patients with the highest MPV: 59% (23 events), 34% (14 events), 27% (11 events), and 18% (6 events), respectively, for the fourth, third, second, and first quartiles (p = 0.001). Multivariate analysis confirmed an independent association between MPV and VA dysfunction—OR 1.52 (1.13–2.07), p < 0.001. VA dysfunction is predicted by MPV level. Patients with the highest MPV have the highest risk of VA events.

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“…It has been established that to reduce blood clots formation, a fistula with an outflow vein length sufficient for puncturesat least 30-35 cm is required [7]. Studies have shown that the risk of thrombosis is significantly reduced with minimum access flow in the fistula of about 580 ml/min [20]. In addition to visualizing thrombotic masses in the vessel lumen, ultrasound criteria for arteriovenous fistula thrombosis include the absence of vein compressibility and impaired blood flow phasicity during breathing [8].…”

Section: Arteriovenous Fistula Thrombosismentioning

confidence: 99%

Ultrasound Diagnostics of Hemodynamic Changes in Arteriovenous Fistula for Hemodialysis: Review

Koen¹,

Захматова²

2019

Proceedings of the International Conference on Health and Well-Being in Modern Society (ICHW 2019)

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The socioeconomic significance of chronic kidney disease in the terminal stage is due to the fact that expensive methods of treatment are required, the number of patients on hemodialysis increases annually and most of them are of working age. The most preferred vascular access for hemodialysis treatment is an arteriovenous fistula, yet its dysfunction occurs in more than 30% of patients. Adequate long-term functioning of the fistula depends on its successful maturation, timely diagnosis and elimination of possible complications of permanent vascular access. The main method for diagnosing dysfunction of an arteriovenous fistula is duplex ultrasound, which allows determining the diameters, the state of the walls and blood vessels lumen, the access flow, identifying such complications as stenosis of inflow artery, anastomotic zone and outflow vein, fistula thrombosis, hand ischemia. Ultrasound diagnosis of vascular access complications allows for their timely correction, which increases the duration of fistula adequate functioning.

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Duplex Ultrasound for the Prediction of Vascular Events Associated with Arteriovenous Fistulas in Hemodialysis Patients

Abstract: US evaluation of AVFs in HD patients is a simple method to predict the risks of thrombosis and fistula dysfunction. Qa, ferritin, transferrin saturation, and warfarin use might be associated with VEs.

Cited by 29 publications

References 26 publications

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Mean Platelet Volume Predicts Vascular Access Events in Hemodialysis Patients

Ultrasound Diagnostics of Hemodynamic Changes in Arteriovenous Fistula for Hemodialysis: Review

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